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Serous Macular Detachment and Optic Disc Edema in a Patient with Iron-Deficiency Anemia: A Case Report
缺鐵性貧血病人併發視神經水腫以及黃斑部漿液性視網膜剝離
摘要
目的：報告一名45歲女性缺鐵性貧血病人併發右眼視神經水腫以及黃斑部漿液性視網膜剝離之病例報告。 方法：病例報告。 結果：一名45歲女性因近兩、三日來右眼視力模糊，看東西扭曲變形，並且有飛蚊症而前來就診。眼科檢查發現右眼最佳矯正視力為20/200，左眼最佳矯正視力為20/20。眼底檢查呈現右眼視神經盤充血性水腫，併有黃斑部漿液性視網膜剝離。自動視野檢查發現右眼上半部視野缺損。全身檢查及神經學檢查並無異狀，頭部核磁共振檢查也未發現顱內或眼框內病變。回溯其病史，發現病人有缺鐵性貧血之病史，而實驗室抽血檢查顯示其缺鐵性貧血未獲得妥善之治療。在給予鐵劑治療改善其缺鐵性貧血之後，病人右眼最佳矯正視力在四個月之後恢復至20/20。 結論：缺鐵性貧血之病人可能併發視神經水腫以及黃斑部漿液性視網膜剝離，致病之機轉主要為缺血性之變化，類似缺血性視神經病變，及時的矯正其缺鐵性貧血，仍然有很好的預後，未出現不可逆之病變。臨床眼科醫師除了眼科檢查外也應該仔細詢問內科之疾病病史。
關鍵字
無資料並列摘要
Purpose: To report a case of serous macular detachment and optic disc edema in a 45-year-old woman with iron-deficiency anemia. Method: A case report. Results: A 45-year-old woman presented with visual loss, metamorphopsia and floaters in her right eye which had developed over the previous 2-3 days. Eye examination revealed a best-corrected visual acuity of 20/200, hyperemic diffuse disc edema, and shallow serous macular detachment OD. Automated Octopus perimetry indicated an upper altitudinal defect. Neurological and general examinations were unremarkable. A magnetic resonance imaging (MRI) of the brain with contrast was normal. Her medical history showed that she had chronic iron-deficiency anemia. Laboratory studies showed hemoglobin 8.4 g/dL, hematocrit 30%, and ferritin 3.6 ng/ml. The patient was then treated regularly with an iron supplement and the hemoglobin returned to 13.4 g/dL two months later. Her best-corrected visual acuity improved to 20/20 and the optic disc was still pinkish in the right eye four months later. Conclusion: Optic disc swelling and serous macular detachment may develop in a patient with iron-deficiency anemia. The pathogenesis mechanism might be related to ischemic change. Clinical physicians should carefully review the patients' medical history. The visual outcome was excellent after treatment for the underlying systemic disease.