脉络膜结核瘤临床特征及治疗预后分析  

Clinical manifestations and prognosis of choroidal tuberculoma

作　　者：蒋婷婷 陈文文 刘卫 陈倩 常青 Jiang Tingting;Chen Wenwen;Liu Wel;Chen Qian;Chang Qing(Department of Ophthalmology,Shanghai Eye&ENT Hospital of Fudan University,Shanghai 200031,China)

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：《中华眼底病杂志》2023年第9期741-746,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金面上项目(82171078)。

摘　　要：目的观察脉络膜结核瘤患者临床特征及治疗预后。方法回顾性、观察性研究。2011年至2022年于复旦大学附属眼耳鼻喉科医院眼科检查确诊的脉络膜结核瘤患者15例16只眼纳入研究。患眼行最佳矫正视力(BCVA)、眼底彩色照相、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)检查。全身胸部CT检查以及实验室结核菌素试验、干扰素释放试验检查。BCVA检查采用Snellen视力表进行,记录时换算为最小分辨角对数(logMAR)视力。患者均给予抗结核治疗,持续时间12~15个月;联合口服糖皮质激素治疗13例。平均随访时间36个月。治疗前后logMARBCVA比较采用秩和检验。结果15例患者中,男性5例,女性10例;双眼受累1例。结核菌素试验强阳性7例;干扰素释放试验阳性8例。伴肺结核6例;腹膜结核1例。16只眼中,病灶位于后极部12只眼,其中视盘结核瘤1只眼;病灶位于周边部4只眼。伴眼前节、玻璃体炎症各9只眼;渗出性视网膜脱离7只眼。OCT检查,病灶处脉络膜基质层弱反射性增厚,对应处视网膜穹窒状抬高,多伴有视网膜下液;FFA检查,病灶晚期呈强荧光,伴视网膜下液者,晚期荧光素积存;ICGA检查,全程病灶呈弱荧光。治疗后,脉络膜病灶均消退,随访期间无复发。因并发性白内障行白内障超声乳化摘除手术4只眼;并发孔源性视网膜脱离行视网膜脱离复位手术1只眼;继发脉络膜新生血管1只眼,行抗血管内皮生长因子药物治疗。出现巩膜穿破1只眼,经治疗后病情稳定。治疗前、末次随访时,患眼平均1ogMARBCVA分别为1.02±0.57、0.31±0.35;治疗前、末次随访平均1ogMAR BCVA比较,差异有统计学意义(P<0.05)。结论脉络膜结核瘤诊断需结合病史、眼部体征、实验室及影像学检查结果综合判断。主要表现为后极部视网膜下黄白色病灶;规范化抗结核治疗可以有效改善视力预后。Objective To investigate the clinical features and prognosis of patients with choroidal tuberculoma.Methods A retrospective and observational study.From 2011 to 2022,15 patients(16 eyes)with choroidal tuberculoma diagnosed and treated in Department of Ophthalmology,Shanghai Eye&ENT Hospital of Fudan University were included.The patients underwent examinations including best corrected visual acuity(BCVA),fundus color photography,optical coherence tomography(OCT),fluorescein fundus angiography(FFA),and indocyanine green angiography(ICGA).Chest CT examination,purified protein derivative test and interferon-release test were also performed.BCVA was performed using the Snellen visual acuity chart,which was converted to Logarithm of the minimum angle of resolution(logMAR)visual acuity when recorded.All the patients received antitubercular therapy and the duration was 12-15 months.Thirteen patients were combined with oral corticosteroids.The average follow-up time was 36 months.Rank sum test was used to compare logMAR BCVA before and after treatment.Results Among the 15 patients,5 were male and 10 were female;1 case was bilateral involvement;7 patients had a strong positive tuberculin skin test;8 patients had a positive interferon-release assay.Six patients had pulmonary tuberculosis.One patient had peritoneal tuberculosis.Lesions were located in the posterior pole in 12 eyes,1 eye with papillary tuberculoma.Peripheral lesions were found in 4 eyes.There were 9 eyes each with anterior segment inflammation or vitreous inflammation;7 eyes were with exudative retinal detachment.OCT examination revealed a hyporeflective thickening of the choroidal stroma,the corresponding elevation of the retina,and often accompanied by subretinal fluid.FFA revealed hyperfluorescence of the mass and fluorescence accumulation with subretinal fluid at the late stage.ICGA revealed hypofuorescence of the lesion.The lesions subsided after treatment,and there was no recurrence during follow-up period.Cataract surgery was performed in 4 eyes due to

关 键 词：脉络膜结核瘤 结核 预后 

分 类 号：R529.8[医药卫生—内科学]