目的：回顾性分析以双眼复视为主要症状患者的病因及临床特点。方法：总结2021年1月至2022年3月就诊于潍坊医学院附属医院神经眼科的双眼复视患者的临床资料，分析其病因及临床特点。结果：共29例患者，男16例，女13例，年龄17岁～81岁，平均(59±14)岁；其中血管性因素8例，包括脑血管病5例，后交通动脉瘤2例，核间性眼肌麻痹1例；炎症、免疫性因素8例，包括重症肌无力4例，Tolosa-Hunt综合征2例，肥厚性硬脑膜炎1例，炎性假瘤1例；内分泌因素9例，包括糖尿病外周神经病变5例，甲状腺相关眼病4例；肿瘤2例，包括动眼神经鞘瘤1例，眼眶MALT淋巴瘤1例，外伤2例。结论：双眼复视的病因复杂，临床医生应重视筛查全身疾病，参照先定位，后定性原则，提高诊断正确率、减少误诊率。
Objective: The etiology and clinical characteristics of patients with binocular diplopia as main symptom were investigated using retrospective analysis method. Methods: The clinical data of patients with binocular diplopia treated in department of ophthalmolog y, affiliated hospital of Weifang Medical University from January 2021 to March 2022 was summarized and the etiology and clinical characteristics retrospectively. Results: There were totally 29 patients, 16 males and 13 females, aged from 17 to 81 years, with an average of (59 ± 14) years; among them, there were 8 cases derived from vascular factors, including 5 cases with cerebrovascular disease, 2 cases with posterior communicating artery aneurysm and 1 case with internuclear ophthalmoplegia. There were 8 cases derived from inflammatory and immune factors, including 4 cases with myasthenia gravis, 2 cases with Tolosa-Hunt syndrome, 1 case with hypertrophic meningitis and 1 case with inflammatory pseudotumor. There were 9 cases derived from endocrine factors, including 5 cases with peripheral neuropathy in diabetes and 4 cases with thyroid related ophthalmopathy. There were 2 cases derived from tumors, including 1 case with oculomotor schwannoma, 1 case with orbital MALT lymphoma and there were 2 other cases of trauma. Conclusions: The etiology of binocular diplopia is complicated and the clinicians should pay attention to the screening of systemic diseases of patients refer to the principle of localization diagnosis first and qualitative analysis next so as to improve the diagnostic accuracy and reduce the misdiagnosis rate.
报告一例视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)合并人体免疫缺陷病毒(human immunodeficiency virus,HIV)感染/获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)，并通过文献复习，总结其发病机制、临床特征、治疗及预后。检索文献包括7篇英文文献(8个病例)，1篇中文文献，共报道9例NMOSD合并HIV感染/AIDS病例，结合本文报道的1例共10例，其中5例为女性，5例为男性，3例HIV感染/AIDS为新发，其他病例的HIV感染/AIDS发病均早于NMOSD。临床表现上，7例均为视神经炎和脊髓炎同时或相继发生，2例表现为单相病程或复发性脊髓炎，1例仅表现为双眼相继发生的视神经炎，10例患者头或脊髓MRI均有典型的视神经或脊髓异常信号，伴或不伴强化。2例患者未进行水通道蛋白4(aquaporin protein-4,AQP4)抗体IgG检测，其余8例中5例AQP4抗体阳性、3例阴性。针对AIDS的治疗，10例患者中，8例接受了高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)。针对NMOSD的治疗，10例患者中，急性期有8例患者接受糖皮质激素冲击治疗、3例患者接受血浆置换、2例接受丙种球蛋白治疗，序贯治疗期有6例患者接受免疫抑制剂治疗，其中1例因高胆红素血症停药。发生视神经炎的7例中，2例患者经治疗仍失明、5例视力部分恢复，发生脊髓炎的8例中，5例患者遗留截瘫或轻瘫、3例肌力部分恢复。1例因严重并发症去世。NMOSD合并HIV感染/AIDS临床较罕见，预后差，往往遗留严重的视力障碍及瘫痪等，临床治疗较为棘手，糖皮质激素和免疫抑制剂并非使用禁忌证，但制定治疗决策前需要充分考虑风险与获益的平衡。
A case of neuromyelitis optica spectrum disorders(NMOSD) complicated with human immunodeficiency virus(HIV) infection/acquired immunodeficiency syndrome(AIDS) was reported, and the pathogenesis, clinical characteristics, treatment and prognosis were summarized through the literature review. The retrieved literatures included seven English literatures (eight cases) and one Chinese literature, in which a total of nine cases of NMOSD co-infected with HIV infection/AIDS were reported. Combined with the case reported in this paper, the total number of cases was ten, among which five cases were female and five cases were male, three cases of HIV infection/AIDS were newly developed, and the other cases had earlier onset of HIV infection/AIDS than NMOSD. In terms of clinical manifestations, seven cases all had simultaneous or sequential optic nerve and myelitis, two patients presented with a uniphasic course or recurrent myelitis, and one case presented only with bilateral optic neuritis occurring sequentially in both eyes. All ten patients had typical abnormal signals of the optic nerve or spinal cord with or without enhancement on cranial or spinal MRI. Two patients did not undergo AQP4 antibody IgG testing , and of the remaining seven cases, five were positive for AQP4 antibodies and three were negative. For AIDS treatment, eight of the ten patients received highly active antiretroviral therapy(HAART). For NMOSD treatment, among the ten patients, eight patients received intravenous methylprednisolone,three patients received plasmapheresis, and two patients received intravenous immunoglobulin in the acute phase. Six patients received immunosuppressive therapy during the sequential treatment period, and one of them was discontinued due to hyperbilirubinemia. Of the seven cases with optic neuritis, two patients remained blind after treatment and five had partial recovery of vision. Of the eight cases with myelitis, five patients were left with paraplegia or mild paralysis, and three had partial recovery of muscle strength. One case died due to serious complications.NMOSD combined with HIV infection/AIDS is rare in clinic and has a poor prognosis. Patients are often left with severe visual impairment and paralysis. Clinical treatment is quite difficult, hormones and immunosuppressive agents are not considered as contraindications. Treatment decisions need to be made with fully considered about the balance of risks and benefits.
脉络膜破裂大部分是由撞击引起的对冲伤，冲击力通过玻璃体传导眼底引起，因此一般脉络膜破裂会有比较明确的外伤或者钝挫伤病史。本文将报告1例16岁体校男生在无明显外伤史出现多发性脉络膜破裂伤，通过查阅文献发现有文献报道在隐匿性假性黄色瘤(pseudoxanthoma elasticum，PXE)疾病中可在无明显外伤或轻微外伤出现脉络膜破裂，并根据文献复习考虑本病例为隐匿性PXE可能。
Most of the choroidal rupture is mostly caused by impact injury, and the impact force is caused by the vitreous conduction through the fundus. Therefore, the choroidal rupture generally has a clear history of trauma or blunt trauma. This article will report a case of a 16-year-old boy in a sports school who developed multiple choroidal ruptures without obvious trauma history. Through literature review, it was found that choroidal rupture can occur without obvious or minor trauma in subtle pseudoxanthoma elasticum (PXE) disease, and based on literature review, this case was considered as a possibility of subtle PXE.
