前后节联合手术治疗复杂性葡萄膜炎的临床疗效  

Clinical Efficacy of Anterior and Posterior Segment Combined Surgery in the Treatment of Complex Uveitis Patients

作　　者：张涛[1] 周强[1] 刘旭辉[1] 陈莉[1] 冯婧 田颖[1] 康皓 胡小凤[1] 陶勇[1] Tao Zhang;Qiang Zhou;Xuhui Liu;Li Chen;Jing Feng;Ying Tian;Hao Kang;Xiaofeng Hu;Yong Tao(Department of Ophthalmology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院眼科,北京100020

出　　处：《中华眼视光学与视觉科学杂志》2022年第11期842-848,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金(82070948、82101142、82101138);北京朝阳医院科技创新基金(2021(5)-1);北京市医院管理中心"青苗"计划(QML20190303)。

摘　　要：目的:探讨前后节联合手术治疗眼后段组织受累的复杂性葡萄膜炎患者的初步临床疗效。方法:回顾性临床研究。收集2018年5月至2021年1月在首都医科大学附属北京朝阳医院眼科接受前后节联合手术的葡萄膜炎合并白内障患者33例(33眼)的临床资料。根据致病原因分为:感染组16例(16眼),其中巨细胞病毒性脉络膜视网膜炎4眼,疱疹病毒性葡萄膜炎3眼,弓形虫性葡萄膜炎2眼,急性视网膜坏死1眼,细菌或真菌性眼内炎6眼;非感染组17例(17眼),其中特发性葡萄膜炎12眼,眼内淋巴瘤1眼,虹膜异色性睫状体炎2眼,幼年特发性关节炎性葡萄膜炎2眼。采用Wilcoxon符号秩检验分析所有患者手术前后的视力、眼压、房水闪辉指数变化以及组间术后视力差异。采用卡方检验比较不同组间术中植入人工晶状体(IOL)及硅油填充比例的差异。结果:全部患者的术前LogMAR最佳矫正视力(BCVA)为2.40(1.50,2.70),术后BCVA为1.70(0.55,2.70),术后视力明显提高(Z=-2.61,P=0.009)。术后,感染组LogMAR BCVA为2.25(2.10,2.93),非感染组为0.92(0.40,1.70),且明显低于感染组(Z=-2.97,P=0.003);感染组视力提高比例为44%,非感染组视力提高比例为71%。全部患者术前眼压为15.0,(10.0,18.5)mmHg(1 mmHg=0.133 kPa),术后眼压为14.0(12.0,16.0)mmHg,手术前后眼压差异无统计学意义(Z=-0.02,P=0.983)。所有患者术前、术后房水闪辉指数分别为12.4(7.5,73.2)pc/ms和5.0(3.3,7.3)pc/ms,术后房水闪辉指数明显下降(Z=-2.99,P=0.003)。感染组植入IOL比例明显低于非感染组(χ^(2)=6.94,P=0.008),2组间硅油填充比例差异无统计学意义(χ^(2)=0.25,P=0.619)。结论:前后节联合手术治疗眼后段组织受累的复杂性葡萄膜炎可以提高患者术后视力,有效控制炎症。Objective:To investigate the clinical outcome of combined anterior and posterior segment surgery in the treatment of patients with refractory uveitis with posterior segment tissue involvement.Methods:The retrospective case series of 33 patients(33 eyes)with refractory uveitis and cataract who underwent combined posterior and anterior approaches in Beijing Chaoyang Hospital from May 2018 to January 2021 were reviewed.According to the etiology,16 infectious uveitis patients(16 eyes,infectious group)were included,consisting of 4 eyes of cytomegalovirus chororetinitis,3 eyes of herpetic uveitis,2 eyes of toxocariasis,1 eye of acute retinal necrosis and 6 eyes of bacterial or fungal endophthalmitis.Seventeen non-infectious uveitis patients(17 eyes,non-infectious group)were also included,consisting of 12 eyes of idiopathic uveitis,1 eye of lymphoma,2 eyes of heterochromic iridocyclitis and 2 eyes of juvenile idiopathic arthritis uvitis.Wilcoxon signed rank test was used to analyze the preoperative and postoperative best corrected visual acuity(BCVA),intraocular pressure and aqueous humor flare index of all patients.The number and percentage of cases were used to show the intraoperative implantation of lens and silicone oil in the infectious uveitis group and non-infectious uveitis group of these patients and compared by the Chi-square test.Results:Preoperative and postoperative logMAR BCVA of all patients were 2.40(1.50,2.70)and 1.70(0.55,2.70)respectively,and the difference was statistically significant(Z=-2.61,P=0.009).The postoperative BCVA of non-infectious uveitis group was 0.92(0.40,1.70),which was significantly lower than that in the infectious uveitis group that was 2.25(2.10,2.93)(Z=-2.97,P=0.003).The proportion of BCVA improvement of the two groups were 44%and 71%respectively.The preoperative and postoperative intraocular pressure of all patients was 15.0(10.0,18.5)mmHg(1 mmHg=0.133 kPa)and 14.0(12.0,16.00)mmHg respectively.There is no statistically significant difference between them(Z=-0.02,P=0.983).Preoper

关 键 词：葡萄膜炎 玻璃体切割术 白内障超声乳化摘除术 

分 类 号：R779.6[医药卫生—眼科]