Zaburzenia układu sercowo-naczyniowego a funkcja oka – opis pacjenta
Cardiovascular Disorders and Eye Function – Case Report
Michał Post, Wojciech Lubiński
Katedra i Klinika Okulistyki Pomorskiego Uniwersytetu Medycznego w Szczecinie
Kierownik: dr hab. n. med. Wojciech Lubiński, prof. nadzw. PUM, FEBO
Summary: Purpose: To present the case of sudden, significant vision loss, secondary to heart failure, and its improvement after artificial pacemaker implantation.
Material and Methods: 71-year old female patient presented atrial fibrillation, ischemic heart disease, systemic hypertension, type 2 diabetes mellitus, underwent internal carotid endarterectomy. The pacemaker was implanted because of complete heart block. Before operation she presented sudden loss of vision with photopsia.
Before and after pacemaker implantation routine ophthalmological examination (the best corrected distance visual acuity, anterior segment and fundus examination, intraocular pressure, Ishihara’s color vision test, kinetic visual field) and electrophysiological tests (flash ERG, ERG pattern, visual evoked potentials) were performed. Preoperatively ultrasonography of the eye, OCT, carotid Doppler, head MRI were carried out.
Results: 1. Ophthalmological examination revealed extraocular cause of vision loss. Loss of vision due to heart failure was definitive diagnosis. 2. The electrophysiological tests revealed retinal and optical pathway disorders, particularly significant cone dysfunction. In this case PVEP, ERG, PERG had critical role in establishing the diagnosis. 3. Only a few days after pacemaker implantation distance visual acuity OD/ OS increased from 0.04 to 0.4. This improvement was associated with a significant restoration of bioelectrical retinal function and visual pathway. Subjective improvement in color vision was also observed.
Conclusions: 1. Cardiovascular diseases can lead to sudden vision disturbances, without significant fundus pathology. 2. Efficient cardiological therapy may significantly improve vision. 3. Electrophysiological tests such as flash/ pattern electroretinography and visual evoked potentials are objective and reliable diagnostic tools.
Słowa kluczowe: nagłe pogorszenie widzenia, niewydolność serca, stymulator serca siatkówka, elektroretinografia, wzrokowe potencjały wywołane.
Keywords: sudden vision loss, heart failure, pacemaker, retina, electroretinography, visual evoked potentials.