新英格兰NEJM:胺碘酮诱发的轮生状角膜病变

一位50岁的的女性自述双眼可看到光晕数周。患者既往无眼外伤史和角膜屈光手术史。2年前患者口服胺磺酮治疗房颤。体格检查发现双眼矫正视力为20/20,并有轻度散光。眼裂隙灯检查示角膜上皮呈轮生状,即胺碘酮诱发轮生状角膜病的典型表现。眼的其它部分正常。轮生状角膜病是胺碘酮常见的副作用。角膜的改变极少引起视力障碍,但是有些患者可能会看到光晕和色环。胺碘酮其他眼部副作用还有白内障和视神经病变。建议患者不用担心,可以配载太阳镜以减轻光晕症状,另外坚持每年门诊随访。最后一次随访是就诊的12个月后,眼科仅有角膜沉积物,其他一切正常。


Amiodarone-Induced Vortex Keratopathy


A 50-year-old woman was referred by her general practitioner after she reported seeing halos around lights through both eyes for a few weeks. She had no history of ocular trauma or previous refractive corneal surgery. She had begun taking amiodarone for atrial fibrillation 2 years previously. On physical examination, her best corrected visual acuity was 20/20 bilaterally. Refraction showed minimal astigmatism. Slit-lamp examination of the anterior segment showed a whorl-like pattern of corneal epithelial deposits bilaterally, characterizing amiodarone-induced vortex keratopathy (also called cornea verticillata). Other ocular structures were normal. Vortex keratopathy is a common side effect of amiodarone. The corneal deposits rarely lead to visual loss, but some patients may see halos and colored rings around lights. Other uncommon ocular toxic effects associated with amiodarone include cataract and optic neuropathy. In this case, the patient was reassured by the clinician and was advised to wear sunglasses for symptomatic relief, with follow-up annually. At her last follow-up, at 12 months after presentation, the ocular examination was normal, apart from the presence of corneal deposits.

全文地址:http://www.nejm.org/doi/full/10.1056/NEJMicm1406501


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