外伤性眼眶骨膜下血肿和眼上静脉压迫症患者的视网膜变化

Gwon Hui Jo, Gye-sang Lim, Kyung Tae Kim, Seong Eun Lee, Eoi Jong Seo
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摘要

目的:我们描述了一例视网膜改变类似于非缺血性视网膜中央静脉闭塞的病例,但也有因外伤性骨膜下眶血肿导致的眼上静脉受压病例。病例摘要:一名 13 岁的男性在钝性眶周外伤后出现左眶周水肿、视力下降和复视。在眼科检查中,最佳矫正视力(BCVA)为 0.4(20/50),且明显存在严重的上睑下垂(-4 级)。眼底检查显示视盘肿胀,视网膜静脉扩张/扭曲,动静脉通过时间延迟 26 秒。荧光素血管造影显示视盘渗漏。眼部超声波检查和眼眶磁共振成像显示,左眼眶内有上骨膜下血肿,并伴有眼上静脉压迫。我们安排了紧急血肿清除术。一个月后,BCVA 增至 1.0(20/20),眼球活动不再受限。眼眶计算机断层扫描显示,眼上静脉压迫症状已经缓解,最初眼底检查和荧光素血管造影观察到的异常情况也有所改善:结论:外伤性眼眶骨膜下血肿后可能会出现类似非缺血性视网膜中央静脉闭塞的视网膜变化,包括视网膜静脉扩张和迂曲。这时,眼上静脉的压迫性阻塞可能会发挥作用。以清除血肿为特征的早期手术干预可防止不可逆转的视力恶化。
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Retinal Changes in a Patient with a Traumatic Orbital Subperiosteal Hematoma and Superior Ophthalmic Vein Compression
Purpose: We describe a case with retinal alterations similar to those of nonischemic central retinal vein occlusion, but also with superior ophthalmic vein compression attributable to a traumatic, subperiosteal orbital hematoma.Case summary: A 13-year-old male presented with left periorbital edema, a decrease in vision, and diplopia after blunt periorbital trauma. In ophthalmological evaluations, the best-corrected visual acuity (BCVA) was 0.4 (20/50) and a severe supraduction limitation was apparent (grade -4). Fundus examination revealed optic disc swelling, retinal vein dilation/tortuosity, and an arteriovenous transit time delay of 26s. Fluorescein angiography evidenced optic disc leakage. Ocular sonography and orbital magnetic resonance imaging revealed a superior subperiosteal hematoma in the left orbit accompanied by superior ophthalmic vein compression. We scheduled emergency hematoma evacuation. One month later, the BCVA had increased to 1.0 (20/20) and ocular movement was no longer limited. Orbital computed tomography showed that the superior ophthalmic vein compression had resolved and that the abnormalities observed in the initial fundus examination and fluorescein angiography had improved.Conclusions: Retinal changes that resemble nonischemic central retinal vein occlusion including retinal venous dilation and tortuosity may develop after a traumatic, orbital subperiosteal hematoma. Compressive obstruction of the superior ophthalmic vein may then be in play. Early surgical intervention featuring hematoma evacuation may prevent irreversible visual deterioration.
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