幼儿急性视网膜坏死之病例报告

Pediatric Acute Retinal Necrosis—A Case Report

摘要: 目的：报告一个5岁女童罹患急性视网膜坏死之少见病例。方法：病例报告。结果：一名5岁女童因多日前突发性右眼红痛及视力模糊而求诊，病患于1岁时曾有疱疹病毒性脑炎之病史。眼科理学检查发现右眼视力为0.1，左眼为1.0。裂隙灯检查发现右眼前房及玻璃体皆有中度炎症反应，视网膜周边则出现坏死性区域。由于其典型之眼底病灶，故诊断为急性视网膜坏死，并开始给予静脉注射Acyclovir及类固醇眼药水治疗。儿科检查和实验室测试，包括免疫测试，都是正常的。十天后改为口服Valaciclovir并加上口服类固醇治疗。药效初期反应良好，三星期后视网膜坏死区域已减少，患眼视力也进步至0.3；口服类固醇逐步减量，原先之病灶于4星期后皆已消失，仅留下视网膜色素层变化，但于治疗7星期后倂发裂孔性视网膜剥离。结论：我们报告一例急性视网膜坏死发生于5岁女童之少见病例，病患经全身性抗病毒药物合倂口服类固醇治疗后一度恢复良好，但于治疗7星期后倂发裂孔性视网膜剥离。

Abstract: Purpose: To report an uncommon case of acute retinal necrosis in a 5-year-old girl. Methods: Case report. Results: A 5-year-old girl presented with redness, ocular pain and blurred vision present for few days on the right eye. The past medical history revealed herpetic encephalitis at the age of 1. On examination, visual acuity was 6/60 on the right and 6/6 on the left. Slit-lamp examination showed moderate anterior uveitis and vitritis in her right eye. Fundoscopy showed large areas of peripheral circumferential retinal necrosis. Under the diagnosis of acute retinal necrosis due to its typical fundus lesions, treatment with intravenous Acyclovir and topical steroid eyedrops were started immediately. Pediatric examination and laboratory testing, including immunologic tests, were normal. After 10 days, treatment was changed to oral Valaciclovir and Prednisolone. Topical treatment was tapered gradually. The response was well initially, with resolution of retinitis patches and improvement of visual acuity to 6/20 in 3 weeks. Oral steroids were gradually reduced, and original lesions completely disappeared in 4 weeks, leaving only retinal pigment epithelial change. Seven weeks later, vision dropped to counting finger on the right due to rhegmatogeous retinal detachment. Conclusion: We report an uncommon case of acute retinal necrosis in a 5-year-old girl. This patient responded well to systemic antiviral medication and steroid initially but developed rhegmatogeous retinal detachment 7 weeks later.