眼内液检查在儿童葡萄膜炎诊断中的应用  

Application of intraocular fluid examination in the diagnosis of pediatric uveitis

作　　者：周旻[1] 常青[1] 徐格致[1] 陈荣家[1] 毕颖文[1] 江睿[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：《中国眼耳鼻喉科杂志》2010年第3期160-162,I0003,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的探讨眼内液检查在儿童葡萄膜炎诊断中的应用。方法回顾分析18例接受前房或玻璃体液检查的儿童葡萄膜炎的临床特征,并结合眼内液检查作出最后诊断。对患者进行了最佳矫正视力、眼压、B超、超声生物显微镜、间接眼底镜以及RetCam数字视网膜照相机检查。对疑为犬弓蛔虫病例做血清和眼内液酶联免疫吸附测定(enzyme-linked immunosorbent assay,ELISA)。结果最终诊断为眼犬弓蛔虫病的患者有12例,中间葡萄膜炎的5例。眼犬弓蛔虫病多单眼发病,玻璃体条索和视网膜肉芽肿是其典型表现,眼内液和(或)血清ELISA呈阳性,细胞学检查58.3%(7/12)可见嗜酸性细胞。中间葡萄膜炎双眼发病多见,常发生虹膜后粘连、白内障等并发症。结论犬弓蛔虫病在本地区并不少见,诊断性玻璃体手术切除混浊玻璃体后能更清楚地了解眼底情况,取得眼内液做ELISA和病理检查能最终明确诊断;同时行玻璃体手术也是本病的有效治疗方法 。Objective To investigate the application of intraocular fluid examination in the diagnosis of pediatric uveitis. Methods Eighteen cases of pediatric uveitis that underwent intraocular fluid examination were available for the retrospective analysis of ophthalmic clinical and pathologic features. All cases underwent best corrected visual acuity, in- traocular pressure, B scan, ultrasound biomicroscopy, slit-lamp biomieroscope, indirect fundoscopy and RetCam digital retian camera examination. Enzyme-linked immunosorbent assay （ELISA） of serum and intraocular fluid was performed in parts of the patients. Final diagnoses were made combined with clinical and pathologic features. Results Ocular toxo- cariasis was diagnosed in 12 cases and idiopathic intermediate uveitis in 5 cases. In ocular toxocariasis, unilateral presen- tation was common and a peripheral or posterior granuloma with vitreoretinal traction bands was its typical clinical fea- ture. That positive sera and/or intraocular fluid ELISA result and eosinophils were identified in cyto-pathology supported the diagnosis. Intermediate uveitis mostly presented bilaterally with posterior synechiae and cataract. Conclusions Ocu- lar toxocariasis was the most frequent uveitis type that underwent intraocular fluid examiniation in our study. Diagnostic vitrectomy was beneficial for the examination of fundus and for the final diagnosis combined with pathology and ELISA analysis of intraoeular fluid.

关 键 词：葡萄膜炎 眼内液检查 眼犬弓蛔虫病 儿童 

分 类 号：R773[医药卫生—眼科]