Compressive Optic Neuropathy in a Patient with History of Acute Attack Angle Closure Glaucoma

目的：報告一個急性青光眼病史合併壓迫性視神經病變的病例。方法：病例報告。結果：一位61歲女性病患主訴近兩年來左眼視力日漸惡化。病患在八年前曾發生過一次左眼隅角閉鎖性青光眼急性發作，之後並未接受雷射虹膜造口術或藥物治療。病患無其他全身性之疾病。首次門診所見，右眼最佳矯正視力為壹點零，左眼則為零點肆，右眼和左眼眼壓分別為10mmHg以及9mmHg。因為左眼視神經盤蒼白部位大於凹陷部位，加上視野檢查報告呈現左眼顳側偏盲，不同於典型青光眼視神經纖維受損所致之視野變化，因此高度懷疑合併著壓迫性視神經病變。腦部斷層掃描報告發現一壓迫視神經路徑之蝶鞍部腫瘤。病患接著接受腫瘤切除術，經病理切片證實為腦膜瘤。結論：此為一隅角閉鎖性青光眼急性發作病史的病人合併壓迫性視神經病變之病例報告。身為眼科醫師應當注意，當病患的視神經或視野變化不同於典型青光眼病患的時候需考慮合併其他病變的可能性。

關鍵字

無資料

並列摘要

Purpose: To report a case of resolved acute glaucoma coexisting with compressive optic neuropathy. Method: A case report. Case report: A 61-year-old woman presenting with progressive deteriorating visual acuity in the left eye for almost 2 years. She had suffered from acute primary angle closure (APAC) in the left eye eight years ago, but received no laser peripheral iridotomy or medication after resolution of the episode. She denied any systemic diseases. At presentation, the best corrected visual acuity (BCVA) were 6/6 OD and 6/15 OS, the intraocular pressure was 10 mmHg OD and 9 mmHg OS. Because fundoscopy showed pale neuroretinal rim other than an enlarged cup in the left eye and automated perimetry showed dense left hemianopia which respected the vertical line other than field loss characteristic of retinal nerve fiber bundle defect, coexistent compressive optic neuropathy was highly suspected. Computed tomography of the brain revealed a sellar mass which compressed the visual pathway. Tumor removal was done, and meningioma was diagnosed based on pathological findings. Conclusion: We report a case of resolved APAC with coexistent compressive optic neuropathy. Ophthalmologists should keep this possibility in mind and recommend imaging study to glaucoma patients whenever there are atypical optic disc changes or visual field defects.

並列關鍵字

compressive optic neuropathy ； acute primary angle closure

國際替代計量

Compressive Optic Neuropathy in a Patient with History of Acute Attack Angle Closure Glaucoma

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