目的:报道1例进展期假性剥脱性青光眼中的Charles Bonnet综合征.方法:病例报告.结果:一例92岁的马来男性诉2a前出现幻视,并加重2mo.称看见成人及百余儿童生动活泼地出现在不同场合.他甚至有几次看见一只兔子偶尔跑过他的房间.但是,他觉察到这是一种异常的经历.与同年龄人相比,他的认知功能是正常的.精神病学评估包括精神状态检查是正常的.他曾经被诊断患有开角型青光眼,左眼以前接受过常规的白内障手术和小梁切除术.其视力为右眼手动,左眼6/7.5(0.8)伴管状视野.眼底镜检查显示左眼进行性青光眼性视杯加深.目前诊断为右眼大泡性角膜病变合并绝对期青光眼,左眼进展期假性剥脱性青光眼,有功能性滤过泡.结论:对诉有幻视的老年患者,特别是在痴呆和精神病的诊断标准不明确的情况下,诊断通常是很困难的.如果这些患者洞察到不复存在的东西进入其视觉范围,并伴有视觉功能恶化,应高度怀疑患有Charles Bonnet综合征的可能.%AIM: To report a case of Charles Bonnet syndrome in advanced pseudoexfoliative glaucoma.METHODS: Case report.RESULTS: A 92-year-old Malay man presented visual hallucination for 2 years with worsening of his symptoms for the past 2 months. He claimed that he had seen people as well as hundreds of children on separate occasions vividly. He even saw a rabbit running across his room on a few occasions. However, he had insight that this was an abnormal experience. His cognitive function was normal for his age. Psychiatry evaluations including the mental status examination were normal. He was previously diagnosed as open angle glaucoma with history of uneventful cataract surgery and trabeculectomy over his left eye. His vision was hand movement in the right eye and 6/7. 5 in the left eye with tunnel vision.Funduscopy of the left eye showed advanced glaucomatous optic disc cupping. He had right bullous keratopathy with absolute glaucoma and left advanced pseudoexfoliative glaucoma with functioning blebs.CONCLUSION: Elderly patient who presented visual hallucination often poses a diagnostic dilemma especially when the criteria for diagnosis of dementia and psychosis are not conclusive. In such a group of patients who possess the insight into the unreality of what they are seeing with a deteriorating vision, ophthalmologists should therefore raise the suspicion of possible Charles Bonnet syndrome.
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