中华眼底病杂志

中华眼底病杂志

65例诊断不明的葡萄膜炎患者玻璃体切割标本检查诊断结果分析

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目的 观察分析诊断不明的葡萄膜炎患者玻璃体切割标本的诊断阳性率。 方法 回顾性系列病例研究。诊断不明的葡萄膜炎患者65例67只眼纳入研究。其中,男性31例32只眼,女性34例35只眼。年龄6~84岁,平均年龄(55.00±18.56)岁。所有患眼均行常规三通道睫状体平坦部入路玻璃体切割手术,在无灌注的情况下切除并收集核心玻璃体标本及时送检,予微生物涂片及培养、抗原抗体、细胞因子、细胞学、流式细胞术免疫表型分析、基因重排等方式进行检测。分析患眼玻璃体切割标本检查的诊断结果。 结果 67只眼中,通过玻璃体标本查出病因者40只眼,诊断阳性率为59.7%。其中,细菌涂片或培养阳性者20只眼,占总诊断阳性率的50.0%;细胞学、细胞因子、流式细胞术免疫表型分析、基因重排检测高度提示或确诊为淋巴瘤11只眼,占总诊断阳性率的27.5%;病毒IgM、IgG显著增高、Goldmann-Witmer系数C值>3者3只眼,占总诊断阳性率的7.5%;真菌涂片或培养阳性者3只眼,占总诊断阳性率的7.5%;弓蛔虫IgG显著增高2只眼,占总诊断阳性率的5.0%;弓形虫IgG显著增高1只眼,占总诊断阳性率的2.5%。 结论 诊断不明葡萄膜炎患者玻璃体切割标本的诊断阳性率为59.7%。

Objective To analyze the results of diagnostic pars plana vitrectomy (PPV) in patients with uveitis of unknown cause. Methods This is a retrospective case series study. Sixty-five patients (67 eyes) with uveitis of unknown cause were enrolled in this study. There were 31 males (32 eyes) and 34 females (35 eyes). The ages were from 6 to 84 years, with the mean age of (55.00±18.56) years. All eyes were received PPV. Examination of vitreous samples consisted of microbial stains and culture, microbial DNA and antibody detection, cytokine measurement, cytology, flow cytometry and gene rearrangement detection. Results Vitreous analysis was positive in 40 of 67 eyes (59.7%). Positive results indicated bacterial endophthalmitis in 20 of 40 eyes (50.0%), lymphoma in 11 eyes (27.5%), viral IgM and IgG increased significantly in 3 eyes (7.5%), fungal endophthalmitis in 3 eyes (7.5%), IgG of toxocara increased significantly in 2 eyes (5.0%), IgG of toxoplasma Gondii increased significantly in 1 eye (2.5%). Conclusion The diagnostic yield of vitreous samples in uveitis eyes of unknown cause is 59.7%.

关键词: 葡萄膜炎/诊断; 眼内炎/诊断; 淋巴瘤/诊断; 玻璃体切除术

Key words: Uveitis/diagnosis; Endophthalmitis/diagnosis; Lymphoma/diagnosis; Vitrectomy

引用本文: 林海燕, 戴荣平, 林燕楠, 董方田, 张美芬, 陈有信, 闵寒毅, 叶俊杰, 于伟泓, 张潇. 65例诊断不明的葡萄膜炎患者玻璃体切割标本检查诊断结果分析. 中华眼底病杂志, 2017, 33(4): 404-406. doi: 10.3760/cma.j.issn.1005-1015.2017.04.018 复制

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1. Mruthyunjaya P, Jumper JM, McCallum R, et al. Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy[J]. Ophthalmology, 2002, 109(6): 1123-1129.
2. Davis JL, Miller DM, Ruiz P. Diagnostic testing of vitrectomy specimens[J]. Am J Ophthalmol, 2005, 140(5): 822-829.
3. Oahalou A, Schellekens PA, de Groot-Mijnes JD, et al. Diagnostic pars plana vitrectomy and aqueous analyses in patients with uveitis of unknown cause[J]. Retina, 2014, 34(1): 108-114. DOI: 10.1097/IAE.0b013e31828e6985.
4. Yeh S, Weichel ED, Faia LJ, et al. 25-gauge transconjunctival sutureless vitrectomy for the diagnosis of intraocular lymphoma[J]. Br J Ophthalmol, 2010, 94(5): 633-638. DOI: 10.1136/bjo.2009.167940.
5. William A, Spitzer MS, Deuter C, et al. Outcomes of primary transconjunctival 23-gauge vitrectomy in the diagnosis and treatment of presumed endogenous fungal endophthalmitis[J]. Ocul Immunol Inflamm, 2017, 25(2): 239-245. DOI: 10.3109/09273948.2015.1115080.
6. Kanavi MR, Soheilian M, Hosseini SB, et al. 25-gauge transconjunctival diagnostic vitrectomy in suspected cases of intraocular lymphoma: a case series and review of the literature[J]. Int J Ophthalmol, 2014, 7(3): 577-581. DOI: 10.3980/j.issn.2222-3959.2014.03.33.
7. Zaldivar RA, Martin DF, Holden JT, et al. Primary intraocular lymphoma: clinical, cytologic, and flow cytometric analysis[J]. Ophthalmology, 2004, 111(9): 1762-1767.
8. Jeroudi A, Yeh S. Diagnostic vitrectomy for infectious uveitis[J]. Int Ophthalmol Clin, 2014, 54(2): 173-197. DOI: 10.1097/IIO.0000000000000017.
9. Raparia K, Chang CC, Chevez-Barrios P. Intraocular lymphoma: diagnostic approach and immunophenotypic findings in vitrectomy specimens[J]. Arch Pathol Lab Med, 2009, 133(8): 1233-1237. DOI: 10.1043/1543-2165-133.8.1233.
10. Hwang CS, Yeh S, Bergstrom CS. Diagnostic vitrectomy for primary intraocular lymphoma[J]. Int Ophthalmol Clin, 2014, 54(2): 155-171. DOI: 10.1097/IIO.0000000000000022.
11. Ohta K, Sano K, Imai H, et al. Cytokine and molecular analyses of intraocular lymphoma[J]. Ocul Immunol Inflamm, 2009, 17(3): 142-147. DOI: 10.1080/09273940802702553.
12. Mudhar HS, Sheard R. Diagnostic cellular yield is superior with full pars plana vitrectomy compared with core vitreous biopsy[J]. Eye (Lond), 2013, 27(1): 50-55. DOI: 10.1038/eye.2012.224.
13. Margolis R. Diagnostic vitrectomy for the diagnosis and management of posterior uveitis of unknown etiology[J]. Curr Opin Ophthalmol, 2008, 19(3): 218-224. DOI: 10.1097/ICU.0b013e3282fc261d.
14. Turno-Krecicka A, Misiuk-Hojlo M, Grzybowski A, et al. Early vitrectomy and diagnostic testing in severe infectious posterior uveitis and endophthalmitis[J]. Med Sci Monit, 2010, 16(6): 296-300.