Survey of ophthalmology最新文献_第4页

Retinal vessel analysis to assess microvascular function in the healthy eye: A systematic review on the response to acute physiological and pathological stressors 视网膜血管分析评估健康眼睛的微血管功能：对急性生理和病理应激反应的系统综述。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-24 DOI: 10.1016/j.survophthal.2024.11.008

Jan Van Eijgen , Lien Van Winckel , Henner Hanssen , Konstantin Kotliar , Thomas Vanassche , Emeline M Van Craenenbroeck , Véronique Cornelissen , Amaryllis H Van Craenenbroeck , Elisabeth Jones , Ingeborg Stalmans

The retina allows noninvasive in vivo assessment of the microcirculation. Autoregulation of the retinal microvasculature meets the changing requirements of local metabolic demand and maintains adequate blood flow. Analysis of the retinal vascular reactivity contributes to the understanding of regulatory physiology and its relationship to the systemic microcirculation. We conducted a literature review on the effect of different acute stimuli onto the retinal vasculature was conducted in accordance with the PRISMA guidelines. A literature search between 1-1–2005 and 17–10–2022 was performed in Medline, Embase, Web of Science and the Cochrane Library. We report the retinal vascular behavior of healthy individuals in response to both physiological and pathological stressors in 106 included articles. We provide ables of methodological characteristics for each stressor. Hypoxia, hypercapnia, high altitude, flicker light stimulation, rise of core temperature, blood pressure lowering, and the condition immediately after endurance exercise associate with larger retinal vessels. Hyperoxia, hypocapnia, blood pressure rise (Bayliss effect), and the condition during isometric exercise associate with smaller retinal vessels. The retinal vasculature is highly reactive to physiological and pathological stressors. This autoregulatory capacity is hypothesized to be a source of biomarkers for vascular health. Dynamic and static retinal vessel analysis are noninvasive methods to assess this (micro)vascular function. Exploring its diagnostic potential and application into clinical practice requires the development of standardized assessment methods, for which some recommendations are made.

视网膜可以对微循环进行无创的活体评估。视网膜微血管的自动调节可满足局部代谢需求的变化，并保持足够的血流量。对视网膜血管反应性的分析有助于了解调节生理及其与全身微循环的关系。我们根据 PRISMA 指南对不同急性刺激对视网膜血管的影响进行了文献综述。我们在 Medline、Embase、Web of Science 和 Cochrane 图书馆对 2005 年 1 月 1 日至 2022 年 10 月 17 日期间的文献进行了检索。我们在 106 篇纳入的文章中报告了健康人在生理和病理压力下的视网膜血管行为。文中提供了每种应激源的方法学特征表。缺氧、高碳酸血症、高海拔、闪烁光刺激、核心体温升高、血压降低以及耐力运动后立即出现的状况都会导致视网膜血管变大。高氧、低碳酸血症、血压升高（贝利斯效应）和等长运动时的状态与视网膜血管变小有关。视网膜血管对生理和病理压力具有高度反应性。这种自动调节能力被认为是血管健康生物标志物的来源。动态和静态视网膜血管分析是评估这种（微）血管功能的非侵入性方法。探索其诊断潜力并将其应用于临床实践需要开发标准化的评估方法，为此提出了一些建议。

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引用次数: 0

Functional diabetic retinopathy: A new concept to improve management of diabetic retinal diseases 功能性糖尿病视网膜病变：改善糖尿病视网膜疾病管理的新概念。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-23 DOI: 10.1016/j.survophthal.2024.11.010

Bhim B. Rai , Ted Maddess , Christopher J. Nolan

Multifocal functional tests are not routinely performed in diabetic retinopathy (DR) and diabetic macular edema (DME) management. We emphasise their importance and coin the term functional diabetic retinopathy (FDR). We reviewed current guidelines on management of DR/DME, and literature on diabetic retinal neurodegeneration (DRN) and functional deficits in DR/DME. Functional visual loss due to DRN precedes vasculopathy and clinical DR; however, currently the diagnosis and management of DR/DME are based on classical signs of retinal vasculopathy and structural changes shown by funduscopy, fundus photographs, and optical coherence tomography (OCT). Furthermore, DME can mask DRN-based retinal layer thinning by OCT and is focussed on the macular region. The only functional test recommended in national and international guidelines on DR/DME is best-corrected visual acuity, a test of foveal function (<1 % of retina). Multifocal functional tests can objectively characterize both foveal and extrafoveal, localized and global, function. Current recommendations for DR/DME screening are inadequate to detect FDR affecting the greater retina. Early detection of FDR using multifocal functional tests could bring DR/DME management strategies forward enabling prevention of the later stage vision-threatening complications. After all, the end point of patient care is functional outcomes.

在糖尿病视网膜病变（DR）和糖尿病黄斑水肿（DME）管理中，多灶功能检测并非常规。我们强调其重要性，并创造了功能性糖尿病视网膜病变（FDR）这一术语。我们回顾了目前有关 DR/DME 管理的指南，以及有关 DR/DME 中糖尿病视网膜神经变性（DRN）和功能障碍的文献。DRN导致的功能性视力损失先于血管病变和临床DR；然而，目前DR/DME的诊断和管理是基于经典的视网膜血管病变征兆以及眼底镜检查、眼底照片和光学相干断层扫描（OCT）显示的结构变化。此外，通过光学相干断层扫描（OCT），DME 可掩盖基于 DRN 的视网膜层变薄，并集中在黄斑区。关于 DR/DME 的国家和国际指南中推荐的唯一功能测试是最佳矫正视力（BCVA），这是一种眼窝功能测试 (

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引用次数: 0

Applications of artificial intelligence to inherited retinal diseases: A systematic review 人工智能在遗传性视网膜疾病中的应用：系统综述。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-19 DOI: 10.1016/j.survophthal.2024.11.007

Mohamad Issa , Georges Sukkarieh , Mathias Gallardo , Ilias Sarbout , Sophie Bonnin , Ramin Tadayoni , Dan Milea

Artificial intelligence(AI)-based methods have been extensively used for the detection and management of various common retinal conditions, but their targeted development for inherited retinal diseases (IRD) is still nascent. In the context of limited availability of retinal subspecialists, genetic testing and genetic counseling, there is a high need for accurate and accessible diagnostic methods. The currently available AI studies, aiming for detection, classification, and prediction of IRD, remain mainly retrospective and include relatively limited numbers of patients due to their scarcity. We summarize the latest findings and clinical implications of machine-learning algorithms in IRD, highlighting the achievements and challenges of AI to assist ophthalmologists in their clinical practice.

基于人工智能（AI）的方法已被广泛用于各种常见视网膜疾病的检测和管理，但针对遗传性视网膜疾病（IRD）的开发仍处于起步阶段。在视网膜亚专科医生、基因检测和遗传咨询有限的情况下，对准确、易用的诊断方法的需求很高。目前，旨在检测、分类和预测 IRD 的人工智能研究仍以回顾性研究为主，而且由于研究数量稀少，纳入的患者人数也相对有限。我们总结了机器学习算法在 IRD 方面的最新发现和临床意义，强调了人工智能在协助眼科医生临床实践方面所取得的成就和面临的挑战。

引用次数: 0

Presumed phototoxicity from macular vital staining with Brilliant Blue G and Trypan Blue: A post-market surveillance study, systematic review, and synthesis of the literature 用亮蓝 G 和胰蓝对黄斑要害染色推测的光毒性：一项上市后监测研究、系统回顾和文献综述。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-19 DOI: 10.1016/j.survophthal.2024.11.006

James E. Neffendorf , Timothy L. Jackson

Vital dyes are used to help visualize the retinal surface during macular surgery; however, they have been associated with phototoxicity. We synthesize and collate post-market surveillance data in two of the most commonly used dyes, Brilliant Blue G and Trypan Blue. We identified 69 cases, 59 of which were from the literature and 10 from manufacturer post-market surveillance. Of 69 vitrectomies, 39 were for macular hole, 24 for epiretinal membrane, 2 for vitreomacular traction, and 4 were not specified. The incidence of dye-mediated phototoxicity is likely rare, but is not possible to quantify, due to potential reporting and publication bias favouring dissemination of unusual safety events, but conversely underreporting is possible. Additionally, phototoxicity was reported prior to the introduction of vital stains, so it can be difficult to establish whether vital staining was contributory. Prolonged surgery and repeat staining were identified as risk factors. Characteristic clinical features were macular pigmentary change with hypo- and hyper-autofluoresence, often sparing the fovea. Final visual acuity tended to be worse than preoperatively, with some cases reduced to counting fingers. A reporting template is provided to encourage complete and standardised toxicity reporting and help build a robust evidence base.

在黄斑手术中，生命染料被用来帮助观察视网膜表面，但它们与光毒性有关。本文献综述和上市后监测数据整理考虑了两种最常用的染料--亮蓝 G 和胰蓝。我们发现了 69 例病例，其中 59 例来自文献，10 例来自制造商的上市后监测。在 69 例玻璃体切除术中，39 例是由于黄斑孔，24 例是由于视网膜外膜，2 例是由于玻璃体粘膜牵引，4 例未作说明。染料介导的光毒性发生率可能非常罕见，但由于潜在的报告和发表偏差有利于异常安全事件的传播，因此无法量化，但反之也可能存在报告不足的情况。此外，光毒性是在引入活力染色之前报告的，因此很难确定活力染色是否是造成光毒性的原因。延长手术时间和重复染色被认为是风险因素。典型的临床特征是黄斑色素改变，伴有低自荧光和高自荧光，通常不影响眼窝。最终视力往往不如术前，有些病例甚至只能数手指。本报告提供了一个报告模板，以鼓励完整、标准化的毒性报告，并帮助建立健全的证据基础。

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引用次数: 0

The adaptive immune system in the retina of diabetics 糖尿病视网膜中的适应性免疫系统。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-19 DOI: 10.1016/j.survophthal.2024.11.005

Yiou Lei , Yani Wang , Siao Tang , Jiaqi Yang , Dongwei Lai , Qinghua Qiu

As the prevalence of diabetes mellitus increases each year, its most common microvascular complication, diabetic retinopathy (DR), is also on the rise. DR is now regarded as an inflammatory disease in which innate immunity plays a crucial role, and a large number of innate immune cells with associated cytokines are involved in the pathologic process of DR. The role of adaptive immunity in DR is seldom mentioned, probably due to the general perception of the immune privileged environment of the retina; however, in recent years there has been a gradual increase in research on the role of adaptive immunity in DR, and with the discovery of the retinal lymphatic system, it seems that the role of adaptive immunity can no longer be ignored. Here, we discuss the immunosuppressive environment of the retina, the phenomenon and potential mechanisms of lymphocyte infiltration in DR, and the role of the adaptive immune system in the diabetic retina, which may point the way for future research.

随着糖尿病发病率的逐年上升，其最常见的微血管并发症--糖尿病视网膜病变（DR）也呈上升趋势。目前，糖尿病视网膜病变被认为是一种炎症性疾病，先天性免疫在其中起着至关重要的作用，大量先天性免疫细胞及相关细胞因子参与了糖尿病视网膜病变的病理过程。然而，近年来有关适应性免疫在 DR 中作用的研究逐渐增多，而且随着视网膜淋巴系统的发现，适应性免疫的作用似乎已不容忽视。在此，我们将讨论视网膜的免疫抑制环境、DR 中淋巴细胞浸润的现象和潜在机制，以及适应性免疫系统在糖尿病视网膜中的作用，为未来的研究指明方向。

引用次数: 0

Uveitis among people with multiple sclerosis: A systematic review and meta-analysis 多发性硬化症患者的葡萄膜炎：系统回顾和荟萃分析。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-17 DOI: 10.1016/j.survophthal.2024.11.002

Saeed Vaheb , Mohammad Yazdan Panah , Vahid Shaygannejad , Aram Zabeti , Omid Mirmosayyeb

People with multiple sclerosis (pwMS) encounter numerous ocular complications, including uveitis. MS-related uveitis is linked to diverse complications, encompassing cataracts, cystoid macular edema, band keratopathy, glaucoma, retinal detachment, retinoschisis, vitreous hemorrhage, and occlusive vasculitis. The relationship between uveitis and MS is firmly established, but various prevalence rates have been reported. Hence, we aimed to determine the overall prevalence of uveitis and its different types among pwMS.

The systematic search was conducted across PubMed/MEDLINE, Scopus, EMBASE, and Web of Science to identify studies published between January 1, 1990, and November 11, 2023. The meta-analysis was performed using R software version 4.3.3 with a random-effect model to calculate the pooled prevalence with a 95 % confidence interval (CI) of uveitis among pwMS.

From a total of 2520 studies reviewed, 12 studies met the inclusion criteria, comprising a total of 54,402 pwMS. Of whom, 72 % were female, and the mean (standard deviation) age was 43.5 (12.1) years. Meta-analysis showed that the pooled prevalence of uveitis among pwMS was 1.1 % (95 % CI: 0.6–1.7 %, I²=95 %, p-heterogeneity<0.01). Moreover, among various uveitis types, intermediate uveitis exhibited the highest prevalence of 0.6 % (95 % CI: 0.2–1.0 %, I² = 87 %, p-heterogeneity < 0.01) in pwMS.

We determined that the prevalence of uveitis among pwMS is 1.1 %. Among different uveitis types, intermediate uveitis stands out as the most prevalent in pwMS. Diagnosing uveitis in pwMS within clinics by specialists is imperative.

多发性硬化症患者（pwMS）会遇到许多眼部并发症，包括葡萄膜炎。多发性硬化症相关葡萄膜炎与多种并发症有关，包括白内障、囊状黄斑水肿、带状角膜病、青光眼、视网膜脱离、视网膜裂孔、玻璃体出血和闭塞性脉管炎。葡萄膜炎与多发性硬化症之间的关系已得到证实，但有不同的患病率报道。因此，本研究旨在确定葡萄膜炎及其不同类型在多发性硬化症患者中的总体发病率。本研究在 PubMed/MEDLINE、Scopus、EMBASE 和 Web of Science 上进行了系统检索，以确定 1990 年 1 月 1 日至 2023 年 11 月 11 日期间发表的研究。荟萃分析使用 R 软件 4.3.2 版和随机效应模型进行，以计算出 pwMS 中葡萄膜炎的汇总患病率和 95% 的置信区间 (CI)。在所审查的 2520 项研究中，有 12 项研究符合纳入标准，共纳入 54402 名 pwMS。其中，72%为女性，平均年龄（标准差）为43.5（12.1）岁。Meta 分析显示，pwMS 中葡萄膜炎的合计患病率为 1.1%（95% CI：0.6% 至 1.7%，I2=95%，p-异质性2=87%，p-异质性<0.01）。目前的研究结果表明，葡萄膜炎的发病率为 1.1%。在不同类型的葡萄膜炎中，中度葡萄膜炎在老年人中发病率最高。当务之急是考虑由专科医生在门诊中诊断 pwMS 中的葡萄膜炎。

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引用次数: 0

Association between retinal vessels caliber and systemic health: A comprehensive review 视网膜血管口径与全身健康的关系：全面回顾。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-16 DOI: 10.1016/j.survophthal.2024.11.009

Si Jin Vanessa Lee , Ying Qi Goh , William Rojas-Carabali , Carlos Cifuentes-González , Carol Y. Cheung , Atul Arora , Alejandra de-la-Torre , Vishali Gupta , Rupesh Agrawal

The unique nature of the retinal microvasculature that permits non-invasive visualization has garnered interest as a potential method for detecting microvascular alterations indicative of systemic diseases. This concept, supported by advancements in imaging technologies, has been increasingly validated by studies linking retinal microvasculature with systemic conditions such as diabetes, hypertension, and cerebrovascular disease. Structural changes in the retinal microvasculature are associated with cardiovascular risk factors, metabolic diseases, and are significant predictors of systemic hypertensive damage and mortality. Given that most systemic diseases present life-long burdens and complications if undetected or untreated, the development of diagnostic tools like retinal vascular imaging becomes important for early detection, monitoring of disease progression, and facilitating timely interventions. Technological advancements have enabled objective and accurate quantification of retinal microvascular characteristics. We consolidate current literature on retinal vascular changes across various systemic health conditions, including metabolic diseases, cerebrovascular diseases, pregnancy complications, systemic inflammatory conditions, leukemia, human immunodeficiency virus infection, and COVID-19. We also emphasizes the need for dynamic parameters, an understanding of 3-dimensional vascular architecture, and larger-scale longitudinal studies to elucidate the temporal relationship between retinal vascular changes and systemic diseases, helping shape future diagnostic and monitoring approaches.

视网膜微血管的独特性质允许进行非侵入性的可视化，这引起了人们的兴趣，因为它是检测微血管病变的一种潜在方法，而微血管病变是全身性疾病的征兆。在成像技术进步的支持下，视网膜微血管与糖尿病、高血压和脑血管疾病等全身性疾病有关的研究越来越多地验证了这一概念。视网膜微血管的结构变化与心血管风险因素和代谢性疾病有关，也是全身性高血压损害和死亡率的重要预测因素。鉴于大多数全身性疾病如果未被发现或治疗，会造成终身负担和并发症，因此开发视网膜血管成像等诊断工具对于早期发现、监测疾病进展和促进及时干预非常重要。技术的进步使得对视网膜微血管特征进行客观准确的量化成为可能。我们整合了目前关于各种全身健康状况下视网膜血管变化的文献，包括代谢性疾病、脑血管疾病、妊娠并发症、全身炎症、白血病、人类免疫缺陷病毒感染和 COVID-19。我们还强调需要动态参数、对三维血管结构的了解以及更大规模的纵向研究来阐明视网膜血管变化与全身性疾病之间的时间关系，从而帮助形成未来的诊断和监测方法。

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引用次数: 0

Antiviral therapy for cytomegalovirus retinitis: A systematic review and meta-analysis 巨细胞病毒视网膜炎的抗病毒治疗：系统回顾和荟萃分析。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-15 DOI: 10.1016/j.survophthal.2024.11.004

Ikhwanuliman Putera , Rina La Distia Nora , Arlin Chyntia Dewi , Ditta Shabrina Suhada , Carlos Cifuentes-González , William Rojas-Carabali , Gazal Patnaik , Germán Mejia-Salgado , Ratna Sitompul , Lukman Edwar , Made Susiyanti , Yulia Aziza , Jyotirmay Biswas , Vishali Gupta , Alejandra de-la-Torre , Rupesh Agrawal

Cytomegalovirus retinitis (CMVR) is a significant cause of blindness in patients with advanced acquired immunodeficiency syndrome (AIDS). There are no established guidelines for its treatment, resulting in varied antiviral approaches. We pooled data from 59 studies (4501 patients) to evaluate treatment variations and outcomes (CRD42022321088). Overall pooled estimates showed visual acuity improvement at 18 % (95 % CI: 7–41 %), inflammation resolution at 90 % (95 % CI: 81–95 %), retinal detachment at 11 % (95 % CI: 8–14 %), and recurrence at 19 % (95 % CI: 11–31 %). The main antiviral treatment approaches identified were: (1) intravenous antivirals alone in 33 studies, (2) intravitreal antivirals alone in 26 studies, (3) oral antivirals alone in 3 studies, and (4) a combination of systemic (oral or intravenous[IV]) and intravitreal antivirals in 7 studies, with varying schemes and durations. Ganciclovir was the predominant antiviral, with intravenous administration being the most reported (in 23 studies), followed by intravitreal administration (in 20 studies). While visual acuity improvement was comparable, inflammation resolution tended to be higher with intravitreal than with IV antivirals, though not statistically significant (88 %, 95 % CI: 69–96 % vs 75 %, 95 % CI: 35–94 %, p = 0.38). Retinitis progression rate for IV ganciclovir was lower than for those without ganciclovir. Inflammation recurrence was significantly lower in antiretroviral (ART)-treated compared to non-ART-treated HIV/AIDS patients (10 % (95 % CI: 4–20 %) vs 33 % (95 % CI: 19–50 %), p < 0.01). Neutropenia, particularly with ganciclovir, was the most reported adverse effect (up to 50 %).

巨细胞病毒视网膜炎（CMVR）是晚期获得性免疫缺陷综合征（AIDS）患者失明的一个重要原因。目前尚无既定的治疗指南，因此抗病毒治疗方法也多种多样。我们汇总了 59 项研究（4,501 名患者）的数据，对治疗方法的变化和结果进行了评估 (CRD42022321088)。总体汇总估计结果显示，视力改善率为 18% (95% CI: 7-41%)，炎症消退率为 90% (95% CI: 81-95%)，视网膜脱离率为 11% (95% CI: 8-14%)，复发率为 19% (95% CI: 11-31%)。已确定的主要抗病毒治疗方法有(1) 33 项研究中仅采用静脉注射抗病毒药物，(2) 26 项研究中仅采用玻璃体内抗病毒药物，(3) 3 项研究中仅采用口服抗病毒药物，(4) 7 项研究中采用全身（口服或静脉注射）和玻璃体内抗病毒药物联合治疗，治疗方案和持续时间各不相同。更昔洛韦是最主要的抗病毒药物，静脉注射的报道最多（23 项研究），其次是玻璃体内注射（20 项研究）。虽然视力改善程度相当，但玻璃体内抗病毒药物的炎症消退率往往高于静脉注射抗病毒药物，但无统计学意义（88%，95% CI：69-96% vs 75%，95% CI：35-94%，P = 0.38）。静脉注射更昔洛韦的视网膜炎恶化率低于未注射更昔洛韦的患者。与未经抗逆转录病毒治疗的艾滋病毒/艾滋病患者相比，接受抗逆转录病毒治疗的患者炎症复发率明显较低（10% (95% CI: 4-20%) vs 33% (95% CI: 19-50%)，p < 0.01）。中性粒细胞减少，尤其是更昔洛韦，是报告最多的不良反应（高达 50%）。

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引用次数: 0

Structural en face optical coherence tomography in neovascular and nonneovascularage-related macular degeneration: Use and utility in clinical practice. 新生血管和非新生血管相关黄斑变性的结构性面光相干断层扫描：临床实践中的使用和效用。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-09 DOI: 10.1016/j.survophthal.2024.11.003

Clara Rizzo, Maria Cristina Savastano, Raphael Kilian, Giorgio Marchini, Stanislao Rizzo

Age-related macular degeneration (AMD) is a leading cause of blindness and visual impairment worldwide. Structural en face optical coherence tomography (OCT) is an innovative imaging technology that has recently attracted interest because of its potential for assessing AMD features. We conducted a comprehensive review of its application in AMD. In neovascular AMD, structural en face OCT can detect exudative activity, monitor the neovascularization area, study the choroid in polypoidal choroidal vasculopathy, and visualize neovascular membranes in pigment epithelial detachments. Moreover, in nonneovascular AMD, this study provides details on geographic atrophy and drusen, the identification of intraretinal retinal pigment epithelium migration, and the detection of different patterns of outer retinal tubulations. Our study revealed that structural en face OCT can provide relevant information on patients with AMD.

老年性黄斑变性（AMD）是导致全球失明和视力损伤的主要原因。结构面光学相干断层扫描（OCT）是一种创新的成像技术，因其在评估老年性黄斑变性特征方面的潜力，最近引起了人们的兴趣。我们对其在 AMD 中的应用进行了全面回顾。在新生血管性黄斑变性中，结构性环面 OCT 可以检测渗出活动、监测新生血管区域、研究多形性脉络膜血管病变中的脉络膜，以及观察色素上皮脱落中的新生血管膜。此外，对于非新血管性黄斑变性，本研究还提供了有关地理萎缩和色素沉着的详细资料，可识别视网膜内视网膜色素上皮的迁移，并检测视网膜外小管的不同形态。我们的研究表明，结构性全脸 OCT 可以为 AMD 患者提供相关信息。

引用次数: 0

Heavy duty 重型。

IF 5.1 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2024-11-08 DOI: 10.1016/j.survophthal.2024.11.001

M. Tariq Bhatti , Darron H. Fors , Irma Muminovic , Shira L. Robbins

A 54-year-old woman with myopia, hypothyroidism, and asthma presented with intermittent double vision. Serum was positive for anti-low density lipoprotein receptor-related protein 4 (LRP4) antibodies suggesting the diagnosis of myasthenia gravis. There was no improvement with pyridostigmine, prednisone, or azathioprine. Over time her double vision became constant, and she was noted to have mild limitation of abduction in both eyes with an esotropia, left hypotropia, and excyclotorsion. Magnetic resonance imaging showed nasal displacement of the superior rectus and inferior rectus muscles, inferior displacement of the lateral rectus muscles and superotemporal globe prolapse consistent with heavy eye syndrome (HES). The differential diagnosis, clinical and radiological manifestations of HES are discussed.

一名 54 岁的妇女患有近视、甲状腺功能减退症和哮喘，并出现间歇性复视。血清中抗低密度脂蛋白受体相关蛋白 4（LRP4）抗体呈阳性，提示诊断为重症肌无力。使用吡啶斯的明、泼尼松或硫唑嘌呤后，病情没有好转。随着时间的推移，她的复视越来越严重，双眼外展轻度受限，并伴有内斜视、左眼视力减退和外旋。磁共振成像显示，她的上直肌和下直肌鼻侧移位，外侧直肌下移，颞上眼球脱垂，与重眼综合征（HES）一致。本文讨论了重眼综合征的鉴别诊断、临床和影像学表现。

引用次数: 0