急性视网膜坏死综合征临床误诊分析  

Clinical Misdiagnosis of Acute Retinal Necrosis Syndrome

作　　者：朱丹妮 吕金丽 刘海峰 ZHU Danni;LV Jinli;LIU Haifeng(Department of Ophthalmology,the 39th Hospital of Qiqihar,Qiqihar 161000,China;Department of Ophthalmology,the Third Hospital of Peking University,Beijing 100191,China)

机构地区：[1]齐齐哈尔三九医院眼科,黑龙江齐齐哈尔161000 [2]北京大学第三医院眼科,北京100191

出　　处：《临床误诊误治》2025年第2期16-19,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析急性视网膜坏死综合征临床误诊原因和纠正误诊的方法,以提高本病诊断率。方法回顾分析2021年4月至2023年5月曾误诊的8例(8眼)急性视网膜坏死综合征的临床资料。结果8例患者中3例因左眼红肿伴视力下降就诊,1例因左眼发红、雾视合并头痛就诊,2例因右眼发红、胀痛、视力下降就诊,1例因右眼微痛、眼红伴畏光、流泪、异物感就诊,1例因右眼视物模糊伴视物变形就诊。初诊为虹膜睫状体炎4例,全葡萄膜炎并视网膜脱离1例,左眼视网膜中央动脉阻塞(颞上分支)1例,右眼出血性视网膜血管炎2例。其中5例对症治疗无效,4例行眼底检查和三面镜检查确诊为急性视网膜坏死综合征,1例行荧光眼底血管造影确诊为急性视网膜坏死综合征;3例行玻璃体手术术中确诊为急性视网膜坏死综合征。8例误诊时间为3 d~8个月。确诊后5例予抗病毒、抗凝、营养支持及玻璃体手术治疗,3例予抗病毒、抗凝、营养支持及视网膜坏死病灶局部激光光凝治疗。随访12个月,3例视网膜保持附着,视力恢复良好,病情无反复;5例视网膜脱离,行平坦部玻璃体切除术。结论急性视网膜坏死综合征患者早期表现与虹膜睫状体炎、出血性视网膜血管炎等相似度较高,易误诊;临床医生应充分掌握该病的临床特点、诊断及鉴别诊断要点,提高警惕性,及早行必要的眼科检查,降低本病早期误诊率。Objective To analyze the causes of clinical misdiagnosis of acute retinal necrosis syndrome(ARN)and the methods of correcting misdiagnosis,so as to improve the diagnosis rate of this disease.Methods The clinical data of 8 patients(8 eyes)with ARN who had been misdiagnosed from April 2021 to May 2023 were retrospectively analyzed.Results Among the 8 patients,3 patients were treated for left eye redness with visual acuity loss,1 patient was treated for left eye redness and blurred vision combined with headache,2 patients were treated for right eye redness,swelling pain and visual acuity loss,1 patient was treated for mild pain in the right eye,red eye with photophobia,tearing and foreign body sensation,and 1 patient was treated for blurred right eye with visual deformation.The initial diagnosis was iridocyclitis in 4 patients,panuveitis with retinal detachment in 1 patient,central retinal artery obstruction in the left eye(superior temporal branch)in 1 patient,hemorrhagic retinal vasculitis in the right eye in 2 patients.Among them,5 patients failed symptomatic treatment,4 patients were diagnosed with ARN by fundus examination and triple mirror examination,and 1 patient was diagnosed with ARN by fluorescence fundus angiography.ARN was diagnosed in 3 patients undergoing vitreous surgery.The misdiagnosis duration of 8 patients was 3 d-8 months.After diagnosis,5 patients were treated with antiviral and anticoagulation treatment,nutritional support and vitreous surgery,and 3 patients were treated with antiviral and anticoagulation treatment,nutritional support and local laser photocoagulation of retinal necrosis lesions.After 12 months of follow-up,3 patients maintained retinal attachment,visual acuity recovered well,and the disease was not repeated.Five patients with retinal detachment were treated with flat vitrectomy.Conclusion The early symptoms of ARN are similar to iridocyclitis and hemorrhagic retinal vasculitis,which is prone to misdiagnosis.Clinicians should fully understand the clinical characteristics,diagno

关 键 词：视网膜坏死综合征 急性 误诊 虹膜睫状体炎 全葡萄膜炎 视网膜脱离 视网膜中央动脉阻塞 出血性视网膜血管炎 诊断 

分 类 号：R774.1[医药卫生—眼科]