巨细胞病毒性角膜内皮炎的诊断与治疗  

Diagnosis and treatment of cytomegalovirus endotheliitis

作　　者：余晨颖[1] 李莹[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼科杂志》2014年第9期711-714,共4页Chinese Journal of Ophthalmology

摘　　要：巨细胞病毒性角膜内皮炎是由巨细胞病毒所引起的角膜内皮炎症反应.由于近年来在角膜内皮炎患者的房水中检测到了巨细胞病毒DNA,这一临床概念才被提出并逐渐受到关注.其发病机制不清,临床表现主要包括发生于免疫功能正常患者的角膜水肿、硬币状/线状角膜后沉积物,前房炎症轻,可伴有眼压升高.该病的诊断应在结合患者病史、临床症状及眼部体征的基础上,通过PCR等技术检测患眼组织中的病原体来加以明确;但由于其临床表现常类似其他疾病,故极易被误诊.巨细胞病毒性角膜内皮炎患者对于全身及局部的抗病毒药物联合局部皮质激素治疗反应良好,因此早期正确诊断该病是减少角膜内皮细胞丧失的关键.而且,若不及时诊断,此类患者常会被给予较大剂量的免疫抑制剂用于炎症的控制,但是这种做法往往会加重眼部感染,从而损害其视力的预后.Cytomegalovirus endotheliitis is an inflammation of the corneal endothelium caused by cytomegaloviruses.It may represent a newly identified clinical entity that has drawn increasing attention since cytomegalovirus DNA was detected from the aqueous humor of a patient with corneal endotheliitis.Its pathogenesis is still unclear,and it typically presents as corneal edema,coin-shaped/linear keratic precipitates,mild anterior chamber inflanmation and with or without raised intraocular pressure in an otherwise healthy individual.In order to make an accurate diagnosis,the patient＆#39;s medical history,clinical manifestations and ocular signs should all be considered,and further detection of pathogens by PCR from the ocular tissue should be done.However,misdiagnoses may occur because cytomegalovirus endotheliitis can mimic other clinical diagnoses.Patients with cytomegalovirus endotheliitis respond to systemic and topical ganciclovir with the use of topical steroids.Therefore,making an accurate early diagnosis is crucial in preventing loss of corneal endothelial cells.Moreover,if left undiagnosed,these eyes often receive increasing amounts of immunosuppressants in attempts to control the inflammation,which may worsen the ocular infection,thus compromising their visual outcomes.

关 键 词：巨细胞病毒感染 角膜炎 内皮 角膜 抗病毒药 

分 类 号：R772.2[医药卫生—眼科]