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Cancer Associated Retinopathy (CAR) in a Patient with Unfavorable Visual Outcome after Cataract Surgery: Case Report
白內障術後視力不良經診斷為癌症相關的視網膜病變：病例報告
摘要
目的：報告一例白內障術後視力恢復不良，經診斷為癌症相關的視網膜病變之個案。 方法：病例報告。 結果：一位76歲男性主訴左眼接受無併發症的白內障手術後4天內，雙眼逐漸視力下降。所有常見術後視力不良的原因都經過徹底檢查，包括眼壓升高，眼內炎，黃斑部水腫及視網膜剝離等鑑別診斷。然而，經過3個月仔細研究後仍無法找出確定診斷，因此，病患被轉診至本院做進一步處置。眼底檢查後，發現雙眼視網膜色素上皮呈斑駁狀，小動脈變細，血管白鞘化；網膜電圖可見錐狀及桿狀細胞的反應顯著降低；以西方墨點法可偵測出病人血清中具有抗recoverin的自體抗體。因此，病患被診斷為癌症相關的視網膜病變。經由全身性檢查後，證實患有非小細胞肺癌，並接受腫瘤科醫師之追踨治療。 結論：成人如有無法解釋的視力減退，並且經網膜電圖檢查後可見錐狀及桿狀細胞的反應顯著降低之情形，均應懷疑癌症相關的視網膜病變。此疾病雖然十分罕見，但仍為白內障術後視力不良的重要鑑別診斷之一。
關鍵字
無資料並列摘要
Purpose: To report a case of cancer associated retinopathy (CAR) presented as unfavorable visual outcome after cataract surgery. Method: Case report. Results: A 76-year-old male complained of bilaterally visual loss within 4 days after an uneventful cataract surgery in the left eye. Results from search for common etiologies affecting postoperative vision such as elevated intraocular pressure, endophthalmitis, cystoid macular edema and retinal detachment were all negative. He was referred to our hospital 3 months after cataract surgery. Fundus examination showed bilateral mottling of retinal pigment epithelium, arteriolar attenuation and sheathing. Rod-response and cone-response electroretinogram showed flat waveform. The patient's serum was positive for anti-recoverin autoantibody by Western blotting. The impression of cancer associated retinopathy was made. After systemic workup, non-small cell lung cancer was detected. The patient was referred to the oncologist for further management. Conclusion: Any adult with unexplained visual loss, flat responses of cone and rod cells should be suspected for CAR. Though rare, the disease should be considered in patients who have unfavorable visual outcome after cataract surgeries.
延伸閱讀
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