Bilateral Vitreous Hemorrhage: An Unusual Presentation of Presumed Ocular Sarcoidosis-Case Report

雙眼玻璃體出血－疑似眼類肉瘤

林家賢(Chia-Shian Lin) ； 許淑娟(Shwu-Jiuan Sheu)

《中華民國眼科醫學會雜誌》 46卷1期 (2007/03) Pp. 56-61

https://doi.org/10.30048/ACTASOS.200703.0010

摘要

目的：報告一例以雙眼玻璃體出血的疑似眼類肉瘤少見表現。
方法：個案報告。
結果：一位35歲女性，除了在雙眼數次復發的葡萄膜炎致羊脂狀的角膜沉積物外，過去沒有任何病史。開始視力右眼是手指數而左眼是手動，兩眼輕微前房發炎與玻璃體出血，全身理學、實驗檢查、胸部X光片均呈現正常，由於持續的狀況，先行左眼平坦部玻璃體切除後再行右眼。手術中均發現雙眼在週邊視網膜有血管發炎合併有脈絡膜結節浸潤，術後房水的結核病培養與PCR均呈現陰性，核醫鎵67掃描顯示在雙側淚腺有panda sign與在縱隔腔淋巴結lambda sign。疑似眼類肉瘤高度懷疑。
結論：眼類肉瘤會以許多的眼睛疾病型式表現，在一個不明原因的玻璃體出血與葡萄膜炎的病人，疑似眼類肉瘤必須被列入鑑別診斷內

並列摘要

Purpose: TO report a rare case of presumed sarcoidosis presented as bilateral recurrent vitreous hemorrhage
Method: a case report
Results: a 35-year-old woman was referred to our department by a local medical doctor due to severe visual impairment for months. She was quite healthy prior to a recurrent episode of uveitis with mutton fat keratic precipitates (Kps) in both eyes since 2002. The initial visual acuity was counting finger in right eye and hand motion in left eye. The slit-lamp microscope showed mild anterior chamber reaction in both eyes. Ophthalmoscopy and B-scan revealed dense vitreous hemorrhage without retinal detachment in both eyes. The results of systemic workup including general physical examination, blood routine, Rheumatic factor (RF), nuclear antibody (ANA), human immunodeficiency virus (HIV), venereal disease research laboratory test (VDRL), anti-cardiolipin antibody, and chest radiography, were within normal ranges. As a result of the persistent vitreous hemorrhage and disabled vision, pars plana vitrectomy was performed in the left eye on May 7(superscript th), 2003 and then the right eye on Jun 25(superscript th), 2003. Sign of peripheral vasculitis with nodular choroid infiltration were noted during the operation in both eyes and aqueous for TB culture and PCR was negative. Gallium-67 scans showed a panda sign of increased uptake in lacrimal 9 lands and lambda sign of lymphnodes in the mediastinum. According to the ophthalmologic and image findings, the case 15 verified to be presumed ocular sarcoidosis.
Conclusion: ocular sacoidosis may be present in various forms of ocular diseases. Hence, in a case of unknown vitreous hemorrhage and uveitis, presumed sarcoidosis should be on the list of differential diagnosis.

並列關鍵字

Branch retinal venous occlusion ； Ocular Sarcoidosis ； Vitreous Hemorrhage