中华眼底病杂志

中华眼底病杂志

12例以视神经受累为首发症状的后巩膜炎临床分析

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目的观察以视神经受累为首发症状的后巩膜炎临床特点、疗效。方法回顾性系列病例研究。临床检查确诊的后巩膜炎患者12例12只眼纳入研究。所有患者均曾在外院被诊断为视神经炎。患者均为女性,单眼。平均年龄(33.86±15.16)岁;发病至就诊时平均病程(24.75±22.91)d。均主述发病时眼痛;自觉视力下降11例。患眼均行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜、B型超声、光相干断层扫描(OCT)、眼底彩色照相、荧光素眼底血管造影(FFA)检查以及球壁厚度测量。行视野检查9只眼。所有患者接受全身和(或)眼局部糖皮质激素治疗。共治疗3个月。回顾分析其临床特征、疗效。结果治疗前,12只眼BCVA<0.1~>0.8。浅层巩膜充血、前房闪辉各3只眼。眼底视盘水肿,不同程度视网膜静脉扩张;黄斑区星芒状渗出3只眼,其中黄斑区视网膜色素上皮(RPE)脱离2只眼。B型超声检查,球壁弥漫性增厚,可见典型“T”形征;平均球壁厚度(2.76±0.68)mm。OCT检查,视盘水肿、隆起;黄斑区隆起呈脱离影像征2只眼。FFA检查,视盘荧光素渗漏,随时间延长而增强。行视野检查的9只眼,视野平均缺损(MD)、模式标准差(PSD)值分别为(12.56±5.73)、(8.15±4.23)dB。治疗后3个月,患眼BCVA>0.1,均有不同程度提高。12只眼中,仍存在轻度巩膜充血、前房闪辉1只眼。所有患眼视盘水肿明显消退。后极部球壁水肿减轻;平均球壁厚度(1.53±0.41) mm;治疗前后球壁厚度比较,差异有统计学意义(t=0.0 035,P<0.05)。黄斑区RPE脱离复位。视盘及黄斑区均未见异常荧光素渗漏。行视野检查的9只眼,平均MD、PSD值分别为(5.19±4.82)、(4.33±3.76)dB;治疗前后MD值比较,差异有统计学意义(t=0.0 260,P<0.05)。结论以视神经受累为首发症状的后巩膜炎好发于中青年患者;少数患者伴有眼前节体征;眼底均有视盘水肿伴视网膜静脉扩张;B型超声检查可见球壁典型T形征。全身和(或)眼局部糖皮质激素治疗可取得较好疗效。

ObjectiveTo summarize the clinical features and visual outcome of posterior scleritis presented with symptoms involving affected optic nerve.MethodsRetrospective case series study. Twelve eyes of 12 female patients with posterior scleritis were included in this study. The average age was 35.2±14.31 years old. The patients got diagnosed with an average of 24.75±22.91 days. Ocular pain was complained in all patients, and blurred vision in 11 patients. The best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp microscope examination, B-scan ultrasound, optical coherence tomography (OCT), fundus photography, fundus fluorescein angiography (FFA) and ocular wall thickness measurement were performed in all patients. Nine eyes received visual field examination. All patients received systemic corticosteroid and steroidal eye drops for 3 months. Clinical features and outcome were retrospectively studied.ResultsBefore treatment, the BCVA was from <0.1 to >0.8. There were 3 eyes with scleral hyperemia, 3 eyes with anterior chamber flares, 12 eyes with papilledema and different degrees of retinal vein dilatation, 3 eyes with star-shaped macular exudates and 2 eyes with macular retinal pigment epithelium detachment. B-scan ultrasound demonstrated that the ocular walls were thickening in all eyes with typical T-sign, and the average thickness was 2.76±0.68 mm. OCT demonstrated optic disc swelling, and the macular retinal detachment in 2 eyes. In the FFA examination, the fluorescein leakage of the disc was enhanced with time. In the Humphrey test, the value of mean deviation (MD) was 12.56±5.73 dB and pattern standard deviation (PSD) was 8.15±4.23 dB in 9 eyes before the treatment. After treatment for 3 months, the symptoms were attenuated and the visual acuity was obviously improved with BCVA>0.1 in all eyes. Scleral hyperemia and anterior chamber flares were only found in 1 eye. The optic disc edema gradually faded away. The ocular wall thickness in the poster part of the eyeball decreased, and the T-sign disappeared in all eyes, the average thickness was 1.53±0.41 mm. Compared with parameters before the treatment, the difference was statistically significant (t=0.003 5, P<0.05). OCT demonstrated the recovery of the macular retinal detachment. There was no abnormal leakage evidenced in FFA in the optic disc and macular. After treatment, the value of MD and PSD was 5.19±4.82 dB and (4.33±3.76) dB, respectively. The difference of MD value between before and after the treatment was significant (t=0.026, P<0.05).ConclusionsPosterior scleritis with an initial symptom of optic nerve was tend to affect middle-aged patients, with clinical manifestations of anterior segment signs in some patients and optic disc swelling with retinal vein dilatation in all patients. B ultrasound examination showed typical T sign. Systemic corticosteroid treatment always obtained remission of the ocular inflammatory activity, and could achieve favorable visual outcome.

关键词: 巩膜炎/诊断; 巩膜炎/治疗; 视神经炎; 疾病特征

Key words: Scleritis/diagnosis; Scleritis/therapy; Optic neuritis; Disease attributes

引用本文: 董志章, 甘一峰, 郑海华, 李梅. 12例以视神经受累为首发症状的后巩膜炎临床分析. 中华眼底病杂志, 2018, 34(4): 372-376. doi: 10.3760/cma.j.issn.1005-1015.2018.04.013 复制

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