急性视网膜坏死的临床特点、治疗和预后

发布时间：2018-04-22 10:10

  本文选题：ARN + VZV　； 参考：《中国协和医科大学》2010年硕士论文

【摘要】： 目的：研究急性视网膜坏死(acute retinal necrosis, ARN)患者临床表现、治疗及预后之间的关系。 方法：对1999年1月至2009年12月期间我院收治的31例ARN患者(42只患眼)的临床资料进行非对照性回顾性分析,其中19名患者取玻璃体液查单纯疱疹病毒(herpes simplex virus, HSV)和巨细胞病毒(cytomegalovirus, CMV)抗体,并计算Goldmann-Witmer系数(C),9名患者玻璃体液采用酶联免疫吸附试验(enzyme-linked immunosorbent assay, ELISA)查水痘带状疱疹病毒(varicella zoster virus, VZV)抗体。 干预：静脉滴注更昔洛韦或阿昔洛韦和玻璃体腔注射更昔洛韦进行抗病毒治疗,口服糖皮质激素进行抗炎治疗,行眼底视网膜激光光凝术预防视网膜脱离(retinal detachment, RD),行玻璃体切除术联合气体或硅油填充术治疗RD。 结果：双眼发病患者共11例,均在全身抗病毒治疗之前发病,所有单眼发病患者(20例)行全身抗病毒治疗后对侧眼均未发病。57.9%(11/19)的患眼有明确致病病毒,其中4只患眼HSV的Goldmann-Witmer系数(CHsv)8,1只患眼CMV的Goldmann-Witmer系数(CcMV)8,1只患眼CHSv和CCMV同时8,此外还有玻璃体HSV和CMV的IgM抗体阳性的患眼各1只,以及VZV的igM抗体阳性的患眼3只。RD组患眼发病距离全身抗病毒治疗时间间隔比无RD组长(P=0.001)。无RD组中初诊矫正视力≥0.1的患眼(71.4%,15/21)比RD组(38.1%,8/21)多(P=0.03)。视网膜主干血管白线(P=0.009)、视乳头苍白(P=0.045)和增殖性玻璃体视网膜病变(proliferative vitreoretinopathy, PVR)(P=0.001)在RD组中更为常见。继发RD前行视网膜激光光凝术(P=0.13)或玻璃体腔注射更昔洛韦(P=0.76)与RD无明显关系。行玻璃体切除联合硅油填充术的患眼(共20只)末次随诊视网膜均在位,30.0%(6/20)的患眼末次随诊矫正视力≥0.1。57.1%(8/14)的无PVR患眼和14.3%(4/28)的PVR患眼末次随诊矫正视力较初诊矫正视力提高(P=0.011)。末次随诊矫正视力≥0.1的22只患眼中,初诊矫正视力≥0.1(23只)的患眼有19只,0.1(19只)的患眼有3只(P=0.000)。与末次随诊矫正视力≥0.1的患眼相比,RD(P=0.000)、视网膜主干血管白线(P=0.005)和PVR(P=0.000)在末次随诊矫正视力0.1的患眼中更为常见。 结论:ARN的致病病毒包括VZV、HSV和CMV。视网膜激光光凝术和玻璃体腔注射更昔洛韦不能预防RD。发生RD的ARN预后较差,影响视力提高的主要因素为PVR。在病变严重威胁视力之前尽早予静脉滴注更昔洛韦能降低发生RD和累及健眼的风险,维持有用视力。玻璃体切除联合硅油填充术有助于改善预后。
[Abstract]:Objective: to study the relationship among clinical manifestation, treatment and prognosis of acute retinal necrosis (ARN) patients. Methods: the clinical data of 31 patients with ARN from January 1999 to December 2009 were analyzed retrospectively. The antibodies against herpes simplex virus (HSV) and cytomegalovirus (CMV) were detected in vitreous body fluid of 19 patients, and the Goldmann-Witmer coefficient was calculated. The antibodies against varicella zoster virus (VZVV) were detected by enzyme-linked immunosorbent assay (ELISAs) in vitreous body fluid of 9 patients with chickenpox herpes zoster virus by enzyme-linked immunosorbent assay (Elisa). Interventions: intravenous drip of ganciclovir or acyclovir and intravitreal injection of ganciclovir for antiviral therapy, oral glucocorticoid for anti-inflammatory treatment, Retinal laser photocoagulation was performed to prevent retinal detachment (RDV) and vitrectomy combined with gas or silicone oil implantation was performed for the treatment of RD. Results: 11 patients with binocular disease were diagnosed before systemic antiviral therapy, and 20 patients with monocular disease were treated with systemic antiviral therapy. There was no disease in the contralateral eye after systemic antiviral therapy. The Goldmann-Witmer coefficients of HSV in 4 eyes were as follows: the Goldmann-Witmer coefficients of CMV in 1 eye and the Goldmann-Witmer coefficient of CMV in 8 eyes. In addition, both CHSv and CCMV were found in 8 eyes. In addition, there were 1 patient eyes with positive HSV and CMV IgM antibody in vitreous body, 1 eye with IgM antibody positive in vitreous body, and 1 eye with IgM antibody positive in vitreous body. And 3 eyes with positive igM antibody in VZV. Rd group had a shorter interval from systemic antiviral therapy than that without Rd group (P < 0. 001). In the non-Rd group, 71.4% of the patients with primary corrected visual acuity 鈮，

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