【摘要】 40岁男性，因“左眼突发视力下降1周”入院。患者3个月前因“左视神经脊髓炎相关视神经炎”行激素冲击及序贯减量治疗，1周前感染新型冠状病毒后自觉左眼视力下降。体格检查：左眼最佳矫正视力为FC/5cm，前节未见明显异常，左眼相对性瞳孔传入障碍(RAPD)(+)，眼底见视盘边界清晰，杯盘比(C/D)约0.5,A:V约2:3，视网膜平伏、色泽正常；右眼未见异常。入院后光学相干层析成像(OCT)检查提示左眼颞下血管弓位置一约2 PD直径的视网膜神经上皮层脱离区域。完善感染相关检查、血清脱髓鞘抗体检测、眼眶磁共振成像(MRI)平扫+增强后，患者确诊：(1)左眼复发性抗体双阴性视神经脊髓炎相关视神经炎；(2)双眼中心性浆液性脉络膜视网膜病变(CSC)。仍予以激素冲击及序贯减量治疗视神经炎，随访观察CSC。治疗6个月后，患者右眼BCVA为0.6，双眼CSC病变消退。讨论体会：视神经脊髓炎相关视神经炎合并未累及中心凹的CSC，仍应该给予规范性的激素冲击治疗及序贯减量。更多还原

【Abstract】 A 40-year-old man presented with 1 week of blurred vision in the left eye. The patient was previously diagnosed with neuromyelitis optica-associated optic neuritis in the left eye 3 months ago and had been treated with high-dose intravenous methylprednisolone in acute phase and low-dose corticosteroid therapy in chronic phase. One week ago, the patient was attacked by Covid-19 coronavirus, and then complained of vision loss in the left eye. The Ocular examination of the left eye showed that the best corrected visual acuity was FC/5cm, no specific abnormality was detected in the anterior segment except for a positive relative afferent pupillary defect. Fundus examination showed the edge of optic disc was clear, and the C/D ratio was 0.5. OCT indicated a detached retinal neuroepithelial layer(approximately 2PD) in the inferotemporal retina. Serum tests of infection and demyelination anti-bodies were negative, while MRI showed remarkable demyelination sign in the left optic nerve. The patient was diagnosed with 1. left recurrent serum-negative neuromyelitis optica-associated optic neuritis, and 2. bilateral central serous chorioretinopathy(CSC). High-dose intravenous methylprednisolone and sequential tapering was still administered for his optic neuritis, with follow-up suggested for CSC. After 6 months of treatment, the BCVA of the left eye was 0.6, and the CSC have resolved in both eyes. Summary: Neuromyelitis optica-related optic neuritis combined with foveal-spare CSC is rare and we still suggest to standardize the treatment of steroid and sequential tapering.更多还原