病毒性前葡萄膜炎治疗的临床观察  

Misdiagnosis of anterior viral uveitis

作　　者：陈银银[1] 成拾明[2] 周霞[2] 张勇[2] 许玲[2] 

机构地区：[1]湖北医药学院附属太和医院内分泌科,湖北十堰442000 [2]湖北医药学院附属太和医院眼科中心,湖北十堰442000

出　　处：《临床眼科杂志》2016年第1期45-48,共4页Journal of Clinical Ophthalmology

摘　　要：目的观察局部联合全身应用抗病毒及皮质类固醇激素治疗病毒性前葡萄膜炎的疗效。方法回顾分析2011年11月至2015年1月在十堰市太和医院眼科中心诊断为病毒性前葡萄膜炎并接受住院治疗患者的病例资料。结果共有20例病毒性前葡萄膜炎纳入本研究。2例患者在外院诊断为开角型青光眼并行小梁切除术,1例患者诊断为继发性青光眼,因眼压难以控制行前房穿刺治疗,5例患者首次我院门诊诊断为青光眼睫状体炎综合征,10例诊断为虹膜睫状体炎,具体类型不清楚,仅2例患者同时伴有角膜内皮炎诊断正确。经过全身与局部抗病毒及激素对症治疗后,患者均得到治愈。治愈后1例既往有眼外伤的患者最佳矫正视力为0.3,2例行小梁切除术的患者最佳视力分别为0.5和0.6,其余患者最佳矫正视力均≥0.8。在2~14个月的随访期间有13例患者（65%）病毒性前葡萄膜炎复发,并再次得到治愈。结论病毒性前葡萄膜炎的误诊或漏诊率仍较高,应加强认识,提高诊疗水平。正确诊断病毒性前葡萄膜炎,同时局部联合全身应用抗病毒及激素药物可以有效治愈病毒性前葡萄膜炎,但复发率仍较高。Objective To investigate the efficacy of topical and systematic antiviral medications in combination with corticosteroids in the treatment of anterior viral uveitis（ AVU）.Methods This is a retrospective case-serials analysis of clinical data of patients with AVU who were hospitalized in Taihe Hospital between November 2011 and January 2015.Results Clinical history of 20 AVU patients were collected and reviewed.Two patients were misdiagnosed as open angle glaucoma and received trabeculectomy.One patient was misdiagnosed as secondary glaucoma and was treated with anterior chamber paracentesis due to refractory elevated intraocular pressure.Five patients were misdiagnosed as glaucomatocyclitic crisis and 10 patients were misdiagnosed as iridocyclitis.Only 2 patients who had coexisting corneal endothelialitis were correctly diagnosed.All AVU patients were cured using topical and general anti-viral medications and corticosteroids.AVU recurred in 13 patients and were cured again in 2~14 months of follow-up.All the patients achieved best corrected visual acuity（BCVA） more than 0.8 except one patient with ocular trauma（ BCVA =0.3） and 2 patients who underwent trabeculectomy（BCVA = 0.5 and 0.6,respectively）.Conclusion Misdiagnosis and missed diagnosis of AVU are common.It is necessary to get more insight into the clinical aspects of AVU to improve diagnosis and treatment.AVU can be cured with timely diagnosis and topical and general medication of anti-viral agents and corticosteroids,but the recurrence rate could be high.

关 键 词：病毒性前葡萄膜炎 抗病毒药物 激素 

分 类 号：R773.9[医药卫生—眼科]