Schwartz综合征早期临床特点、漏误诊原因及治疗  

Clinical features and missed/inaccurate diagnosis and the therapy of Schwartz syndrome

作　　者：薛黎萍[1] 肖丽波[1] 胡敏[1] 李云琴[1] 胡竹林[1] 

机构地区：[1]云南省第二人民医院眼科,昆明650021

出　　处：《中华眼外伤职业眼病杂志》2011年第3期163-165,共3页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：云南省科技厅昆明医学院联合专项基金（2009C135）

摘　　要：目的 探讨Schwartz综合征的临床特征,漏误诊原因和手术方式的选择.方法 Schwartz综合征8例.详细询问病史,双眼裂隙灯显微镜及检查镜检查,观察治疗经过和手术效果.分析诊断的一致性及漏诊、误诊原因.结果 患者18～42岁,均单眼受累,6例有外伤史,首诊误诊为青光眼4例、青睫综合征1例、葡萄膜炎2例.巩膜扣带术治愈4例,玻璃体视网膜联合手术治愈2例,2次巩膜扣带术治愈1例,2次玻璃体视网膜联合手术治愈1例.结论 Schwartz综合征是一种伴有高眼压和葡萄膜炎反应的孔源性视网膜脱离,临床上常误诊为青光眼、葡萄膜炎、青睫综合征而延误治疗.缺乏对眼底的详细检查和对该病临床特征的认识是误诊主要原因.根据玻璃体视网膜增生情况选择巩膜扣带术或玻璃体切除术,视网膜复位后高眼压和葡萄膜炎反应自然好转.Objective To investigate the clinical manifestation, the possible reasons of missed/inaccurate diagnosis and the therapy of Schwartz syndrome. Methods The clinical data of 8 patients with Schwartz syndrome were retrospectively analyzed. The disease history of each patient was carefully recorded,and slit-lamp microscopy and fundus examination were performed on the patients. Visual acuity, intraocular pressure, keratic precipitates（KP）, aqueous flare in anterior chamber, lens, vitreous body, retina and thearapy were noted in detail. The data recorded in other hospitals were analyzed and the reasons of missed or inaccurate diagnosis were analyzed. Results The age of the patients ranged from 18 -42 years, all cases were monocular involved, with eye trauma in 6 patients. Of the 8 cases, 4 cases were misdiagnosed as glaucoma, 1 case as Posner-Schlossman syndrome and 2 cases as uveitis. Scleral buckling operation was used in 4 cases, vitrectomy was used in 2 cases, twice scleral buckling operation was used in 1 case and twice vitrectomy was used in 1 case. All patients had got the retina reattached, and the intraocular pressure decreased to normal and uveitis disappeared. Conclusions Schwartz syndrome is characterized by rhegmatogenous retinal detachment with elevated intraocular pressure and uveitis. Missed and inaccurate diagnosis is mainly due to the unawareness of its clinical feature and overlooked fundus check. scleral buckling and vitrectomy are effective treatments for Schwartz syndrome.

关 键 词：SCHWARTZ综合征 临床特点 误诊 治疗 

分 类 号：R779.6[医药卫生—眼科]