急性视网膜坏死综合征的临床分析  

Clinical analysis on acute retinal necrosis syndrome

作　　者：周旻[1] 高巧云[1] 徐格致[1] 王文吉[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中华眼底病杂志》2009年第6期454-457,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 观察急性视网膜坏死综合征（ARN） 的临床特征。方法 回顾性分析84 例98只眼ARN患者的临床资料。患者进行了最佳矫正视力、眼压、B型超声检查、裂隙灯生物显微镜、前置镜、直接和（或）间接检眼镜结合三面镜检查，屈光间质清楚者行荧光素眼底血管造影。部分患者行聚合酶链反应（PCR）检查鉴定致病病毒种类，明确诊断ARN后抗病毒、选择性激光和玻璃体手术治疗。并对视力和眼底情况进行随访，平均随访时间24.1个月。结果 ANR患者平均发病年龄42.8岁，双眼发病率16.6%，视网膜脱离发生率57.1%。治疗后6个月和12个月以上视力高于0.02者分别为53.5%和35.5%。确诊时间在14 d内的ARN患眼以及双眼发病的继发眼预后较好。水痘带状疱疹病毒是本组ARN的主要致病病毒，占62.5%；单纯疱疹病毒1型ARN 与脑炎等中枢神经系统疾病密切相关。结论 ARN急性起病，视网膜脱离发生率高，后期易出现严重视网膜血管病变，预后差。发病早期临床误诊多见，必要时可做PCR 检查帮助明确诊断。Objective To observe the clinical features of acute retinal necrosis syndrome （ARN）.Methods The clinical data of 84 patients （98 eyes） with ARN were retrospective analyzed. The patietns had undergone the examinations of best visual acuity, intraocular pressure, Bscanning, slitlamp biomicroscope, preset lens, direct and （or） indirect ophthalmolscope,and trihedral reflector; fundus fluorecein angiography had been performed on the patients with clear refracting media. Some of the patients had undergone polymerase chain reaction （PCR） to dectet the types of the causative virus.Medication,laser photocoagulation,and vitreous surgery had been performed on the patients after the diagnosis was confirmed. The visual acuity and the change of ocular fundus had been followed up; the average followup was 24.1 months. Results The average age of the patients at the onset was 42.8 years with the bilateraleye rate of 16.6% and retinaldetachment rate of 57.1%. There were 53.5% and 35.5% patients had the final visual acuity of 〉0.02 after 6 and 12 months, respectively. Better prognosis was found in patients diagnosed within 2 weeks and second involved eye. Varicella zoster virus DNA was identified in 15 patients and herpes simplex virus 1 was found in 3.Conclusions ARN is an acute disease with high incidence of retinal detachment.Serious retinal vasculopathy always happens at the late stage, and the prognosis is poor. Diagnosis in early stage is important and application of PCR will do contribution to the right diagnosis. 

关 键 词：视网膜坏死综合征 急性/诊断 视网膜坏死综合征 急性/外科学 聚合酶链反应/方法 

分 类 号：R774.1[医药卫生—眼科]