Peribulbar Injection of Triamcinolone Acetonide in the Treatment of Recurrent Optic Neuritis in a Patient with Ankylosing Spondylitis

於眼球周圍施打類固醇治療僵直性脊椎炎相關之復發性視神經炎之病例報告

簡克鴻(Ke-Hung Chien) ； 陳柏良(Po-Liang Chen) ； 陳清龍(Ching-Long Chen) ； 李嘉宏(Chia-Hung Li) ； 呂大文(Da-Wen Lu) ； 陳建同(Jiann-Torng Chen)

《中華民國眼科醫學會雜誌》 46卷4期 (2007/12) Pp. 439-444

https://doi.org/10.30048/ACTASOS.200712.0008

摘要

目的：報告於眼球周圍施打類固醇以治療僵直性脊椎炎相關之復發性視神經炎的臨床案例。
方法：病例報告。結果：一位44歲女性主訴近兩週左眼視力模糊。經臨床檢查發現視力只能辨手動，相對性瞳孔傳入徑路缺損及腦部核磁共振確定為球後視神經炎。給予系統性類固醇注射之後，患側視力於九天後進步至6/8.6。接下來的一年之中，視神經炎於右眼反覆發作了六次，系統性檢查發現罹患僵直性脊椎炎，每次都能在給予系統性類固醇之後於短時間內恢復視力，長時間使用類固醇的副作用如庫欣氏症候群、眼壓上升等也逐漸出現。最後一次發作時，與患者討論後決定於患眼周圍施打類固醇(Triamcinolone Acetonide, 10 mg)。患側視力於七天後恢復，於門診追蹤一年後無復發情形發生，使用系統性類固醇的副作用也逐漸消失。
結論：於眼球周圍施打類固醇可以在治療復發性視神經炎方面提供另一個選擇。

並列摘要

Purpose: To report a 44-year-old woman with recurrent optic neuritis treated with a peribulbar injection of Triamcinolone Acetonide.
Method: Case report.
Results: A 44-year-old woman presented with a two-week history of blurry vision in the left eye (OS). A physical examination revealed visual acuity of hand motion (HM) at 30 cm, sluggish pupil light reflex and relative afferent pupillary defect (RAPD) OS. There was no visible swelling of the optic disc or pallor of the optic nerve in either eye. Brain magnetic resonance imaging (MRI) revealed negative studies both in brain and orbit. She was treated with pulse steroid therapy and recovered to best corrected visual acuity (BCVA) of 6/8.6 OS 9 days later. However, six episodes of optic neuritis in the right eye (OD) were noted in the following year. Under the suspicion of autoimmune optic neuritis, further systemic investigations confirmed the diagnosis of ankylosing spondylitis (AS) with recurrent optic neuritis. After repeat courses of pulse steroid therapy, systemic side effects of corticosteroids were noted. We performed peribulbar injections of steroid (Triamcinolone Acetonide, 10 mg) while tapering off the use of systemic oral corticosteroids. She recovered to BCVA of 6/6 OD 7 days later. One year after the last episode, her BCVA was still 6/5 in the both eyes.
Conclusions: This patient with AS and recurrent optic neuritis suffered from systemic adverse effects caused by prolonged systemic corticosteroid therapy. Peribulbar injection of Triamcinolone Acetonide might offer an alternative and effective treatment.

並列關鍵字

ankylosing spondylitis ； peribulbar injection ； recurrent optic neuritis