观察阿昔洛韦干预急性视网膜坏死的不同时机对预后的影响

发布时间：2018-01-19 01:04

本文关键词： 视网膜坏死综合征急性视网膜脱离玻璃体切除术阿昔洛韦预后　出处：《福建医科大学学报》2017年05期 　论文类型：期刊论文

【摘要】：目的比较阿昔洛韦不同用药时机对急性视网膜坏死(ARN)远期视力及并发症的影响。方法回顾性分析18例18只眼出现视网膜脱离的ARN患者的临床资料。根据开始使用阿昔洛韦治疗的不同时间点,将患者分为A组(未早期治疗组,10只眼,发病2~6周开始使用阿昔洛韦)和B组(早期治疗组,8只眼,发病2周内开始使用阿昔洛韦)。18只眼最终均接受玻璃体切除+硅油填充术。比较2组患者手术前后的视力、术中视网膜坏死程度以及术后高眼压、复发性视网膜脱离和视神经萎缩等并发症的发生情况。结果术前视力B组明显优于A组(P=0.004)。术中观察A组10只眼视网膜水肿、漏斗状脱离,蜘蛛网样坏死波及近全周视网膜,甚至赤道部后方;B组8只眼视网膜脱离较局限,坏死灶多位于视网膜周边。术后2月,A组视网膜中央血管闭塞、视乳头色苍白;B组视网膜中周部小血管闭塞,视乳头色淡红。术后复发性视网膜脱离A组(30%,3/10)高于B组(0,0/8)(P=0.216)。2组眼压无显著性差异(P0.05)。术后1年,2组患者视力均有提高,B组明显优于A组(P0.01),且B组的视力提高值也明显高于A组(P0.05)。结论 ARN早期(2周内)全身使用阿昔洛韦等抗病毒药物可明显改善患者远期视力,对减轻闭塞性视网膜中央血管病变和视神经萎缩也发挥关键作用。
[Abstract]:Objective to compare the effects of acyclovir on acute retinal necrosis (ARN). Methods the clinical data of 18 cases (18 eyes) of ARN with retinal detachment were retrospectively analyzed according to the different time points of acyclovir therapy. The patients were divided into two groups: group A (10 eyes without early treatment and acyclovir used 6 weeks after onset) and group B (8 eyes in early treatment group). Acyclovir was used in 18 eyes within 2 weeks. Vitrectomy silicone oil implantation was performed in 18 eyes. The visual acuity, retinal necrosis and intraocular pressure were compared between the two groups. Results the preoperative visual acuity in group B was better than that in group A (P 0.004). Retinal edema and funnel detachment were observed in 10 eyes of group A. Spider-like necrosis affects the retina all around, even behind the equator; In group B, 8 eyes with retinal detachment were localized, and the necrotic foci were mostly located around the retina. On February, the central retinal vessels in group A were occluded, and the papilla was pale. In group B, the small vessels in the middle part of retina were occluded and the papilla was reddish, and 30 / 10 of recurrent retinal detachment in group A was higher than that in group B (30 / 10). There was no significant difference in IOP between 0 / 8 and 0.216.2 groups (P 0.05). The visual acuity of group B was significantly better than that of group A (P 0.01) one year after operation. The visual acuity of group B was significantly higher than that of group A (P 0.05). Conclusion the systemic use of acyclovir and other antiviral drugs can significantly improve the long-term visual acuity of patients with ARN within 2 weeks. It also plays a key role in alleviating central retinal vascular occlusion and optic atrophy.
【作者单位】：北京怡德医院眼科;福建医科大学附属协和医院眼科;
【分类号】：R774.12
【正文快照】： 急性视网膜坏死(acute retinal necrosis,ARN)是Akira Urayama教授于1971年首次描述,1978年正式命名为ARN[1]。1994年,美国葡萄膜炎协会指出,ARN诊断主要依据临床特征及病程发展特点,其临床诊断标准为快速进展的周边视网膜多发黄白色病灶,并发闭塞性动脉炎及玻璃体或前房炎症

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