急性视网膜坏死综合征晚期病例的临床分析

发布时间：2018-09-07 18:37

【摘要】： 目的急性视网膜坏死综合征是临床上相对少见的眼科疾病,其晚期病例因视网膜脱离而预后较差。本文拟通过近年在我院住院的急性视网膜坏死综合征晚期病例,对其临床表现、诊断及治疗做一个总结和分析,从而为该病的诊断和治疗提供依据,减少误诊率,实现该病的早期诊断和早期治疗。方法回顾性调查及分析2008年1月至2010年3月期间在我院眼科中心住院病人中诊断急性视网膜坏死综合征继发视网膜脱离的病例,并对其病程、曾作出的诊断、先前曾给予的治疗方案、和住院手术疗效等方面进行分析,总结急性视网膜坏死综合征这一疾病的诊断和治疗。结果近两年中因急性视网膜坏死综合征晚期继发视网膜脱离的病例共9例(10只眼),入院拟行手术治疗。男性8例9只眼(1例双眼发病),女性1例1只眼,年龄27～63岁,平均年龄50.4±12.5岁。术前视力0.02的1只眼,手动／20cm～手动／眼前5只眼,4眼为光感。7例8只眼在诊断急性视网膜坏死综合征之前曾被误诊,分别在他院误诊为结膜炎、青睫综合症,葡萄膜炎和玻璃体混浊等,2例2只眼为发病初期即在我院诊治的病人；3例3只眼在本次住院前未作抗病毒治疗；发病后7～120天发生视网膜脱离,平均50.9±39.5天。本组9例10只眼均在局麻下接受玻璃体切除硅油填充视网膜复位手术,其中7例8只眼联合眼内光凝,3例联合晶状体超声乳化+人工晶状体植入术,手术后均达视网膜脱离解剖复位,术后视力光感～0.15。1例1只眼术后8个月取油,矫正视力达0.1,视网膜平伏。1例1只眼术后5个月取油,矫正视力达0.15,视网膜平伏。结论急性视网膜坏死综合征是临床上较少见的一种疾病,目前该病的诊断标准明确,但是误诊率仍然较高,初诊时若不散瞳仔细检查眼底,易误诊为葡萄膜炎、青睫综合征等,从而延误治疗。该病晚期的视网膜脱离发生率高,玻璃体切除硅油填充手术可有效达到视网膜解剖复位,术后视力可有一定程度的提高。
[Abstract]:objective
Acute retinal necrosis syndrome (ARNS) is a relatively rare clinical ophthalmic disease with poor prognosis due to retinal detachment. This paper summarizes and analyzes the clinical manifestations, diagnosis and treatment of ARNS hospitalized in our hospital in recent years, so as to provide a basis for the diagnosis and treatment of the disease. Reduce misdiagnosis rate and achieve early diagnosis and early treatment.
Method
A retrospective investigation and analysis of the cases of acute retinal necrosis syndrome with secondary retinal detachment diagnosed in our Ophthalmic Center from January 2008 to March 2010 was made. The course of the disease, the diagnosis made, the treatment schemes given previously, and the effect of hospitalized surgery were analyzed. The comprehensive treatment of acute retinal necrosis was summarized. Diagnosis and treatment of this disease.
Result
In the past two years, 9 cases (10 eyes) with advanced retinal detachment due to acute retinal necrosis syndrome (ARNS) were hospitalized for surgical treatment. There were 8 males (9 eyes) and 1 females (1 eye), aged 27-63 years, with an average age of 50.4 (+ 12.5 years). Sense. 7 cases 8 eyes were misdiagnosed before the diagnosis of acute retinal necrosis syndrome, misdiagnosed as conjunctivitis, cyanociliary syndrome, uveitis and vitreous opacity in his hospital respectively, 2 cases 2 eyes were diagnosed and treated in our hospital at the initial stage of the disease; 3 cases 3 eyes did not receive antiviral treatment before hospitalization; 7-120 days after the onset of the disease occurred retina. The average membrane separation was 50.9 + 39.5 days.
Nine cases (10 eyes) underwent vitrectomy and silicone oil-filled retinal reattachment under local anesthesia. Among them, 7 cases (8 eyes) underwent intraocular photocoagulation, 3 cases (3 eyes) underwent phacoemulsification and intraocular lens implantation. All cases achieved anatomical reattachment of retinal detachment. The postoperative visual acuity of 1 eye was 0.15. In the 1 eyes of the retina, 5 eyes were taken for oil, the corrected visual acuity was 0.15, and the retina was.1.
conclusion
Acute retinal necrosis syndrome (ARNS) is a rare disease in clinic. At present, the diagnostic criteria of ARNS are clear, but the misdiagnosis rate is still high. If the fundus of the eye is not dilated carefully, it is easy to be misdiagnosed as uveitis and cyanociliary syndrome, and so on. The incidence of late retinal detachment is high. Vitrectomy with silicone oil tamponade. Surgery can effectively achieve the anatomical reduction of the retina, and the postoperative visual acuity can be improved to a certain extent.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774

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