后巩膜炎眼科影像学特征

目的：分析总结描述后巩膜炎的眼科影像学特征。 方法：在我院2008-10/2013-06期间确诊的后巩膜炎患者16例21眼的临床资料进行回顾性分析,分析B超、眼底彩色照相、眼底荧光血管造影、CT结果,对后巩膜炎眼科影像学特征进行综合评价与分析。 结果：所有患者均行B超检查,B超表现分为弥漫型和结节型两种,弥漫型表现为巩膜弥漫增厚,其后有筋膜囊水肿性低回声暗区与视神经相连,形成典型的“T”形征;结节型表现为巩膜结节型回声增强,内部结构较规则。 FFA表现为动脉早期见斑驳状相对弱荧光,动静脉期出现多发针尖样强荧光,逐渐变大融合;晚期荧光素渗漏至视网膜下组织;视盘有不同程度的强荧光,边界欠清或不清。 CT结果表现为眼球球壁增厚。 结论：后巩膜炎好发于中青年女性患者,其眼科影像学的表现多变,以B超表现较有特异性;选择合理的眼科影像学检查手段,并结合临床表现,能够准确诊断后巩膜炎,避免漏诊和误诊现象的发生。     

超声诊断后巩膜炎6例

目的 观察后巩膜炎超声检查的声像特征。方法 对6例（9只眼）由眼球疼痛，视力下降的患者，其中男性2例，女性4例，应用B型超声波仪，频率为10MHz的探头，采用经眼睑的直接测量法，行水平和垂直探测，发现有意义的声像图进行冻结、分析。结果 超声探测发现6例（9只眼）患者，玻璃体暗区内后极部见均出现球后壁增厚及团块状回声，球后脂肪垫内见“T”形回声征象，1例发现视网膜脱离声像。同时，该声像图应注意与脉络膜黑色素瘤、眼眶蜂窝组织炎、Grave病、眼内炎等疾病的鉴别诊断。结论 B型超声波检查，经济、可多次重复，后巩膜炎特征性声像，结合临床表现，能较准确的诊断后巩膜炎，可作为临床影像学对后巩膜炎的首选检查。     

后巩膜炎22例临床分析

目的 探讨后巩膜炎的临床表现、荧光素眼底血管造影特征、B型超声扫描检查、CT检查结果、治疗效果及视力预后.方法 自2002年8月至2007年7月间,收治的后巩膜炎患者22例22只眼,观察其临床表现、影像学检查结果、实验室检查结果、治疗效果及其预后.结果 22例患者中,男性5例,女性17例,平均年龄32.4岁.荧光素眼底血管造影显示静脉早期多发性斑点状荧光素渗漏,后期荧光素进入视网膜下组织;B型超声扫描检查和CT检查均可见巩膜呈弥漫性或结节性增厚及神经增粗.所有患者对糖皮质激素和非甾体抗炎剂治疗敏感,治疗后所有患者眼底病变消失,矫正视力恢复,未见严重并发症和视力下降病例.结论 后巩膜炎是一种少见的巩膜炎症,以女性多见,细致的临床检查和影像学检查可减少漏诊或误诊,及时有效地治疗可以控制病情发展.     

后巩膜炎

对闭角型青光眼、脉络膜皱襞、视盘水肿、界线清楚的眼底肿块、脉络膜脱离和渗出性视网膜脱离等许多疾病进行鉴别诊断时,都必须考虑到后巩膜炎。因为此病罕见,故必须高度怀疑。有前巩膜炎、眼痛或胶原血管病病史者,有助于临床医生作出正确诊断。女性患后巩膜炎者较男性常见,但环形睫状脉络膜渗出和脉络膜皱襞则多见于男性。渗出性黄斑脱离和界线清楚的眼底肿块,均常见于女性。本文着重论述了后巩膜炎的临床特征,并介绍了一些有助于确诊的辅助性诊断试验。     

36例葡萄膜转移癌的临床表现和影像检查特征

目的 观察葡萄膜转移癌的临床表现和影像检查特征.方法 临床检查确诊的葡萄膜转移癌患者36例43只眼纳入研究.男性21例,女性15例;年龄28～71岁,平均年龄(47.3±10.2)岁;双眼7例,单眼29例.肺癌30例,乳腺癌3例,胃癌1例,未找到原发肿瘤2例.有原发肿瘤病史20例,首诊眼科16例.所有患者均行视力、眼压、裂隙灯显微镜检查及散瞳眼底检查.行眼部B型超声和(或)彩色多普勒超声血流成像(CDFI)检查22例26只眼;荧光素眼底血管造影(FFA)联合吲哚青绿血管造影(ICGA)检查12例12只眼;双眼MRI和(或)CT检查17例22只眼.观察分析患者临床表现和影像检查特征.结果 43只眼中,转移癌位于虹膜者4只眼;睫状体者3只眼;脉络膜者32只眼.玻璃体重度混浊,眼底不能窥见者4只眼.脉络膜脱离32只眼和睫状体3只眼中,眼底单个病灶26只眼,2个及以上病灶9只眼.睫状体和虹膜转移癌表现为睫状体和虹膜上菜花样肉红色或灰白色肿物,表面呈不规则形,肿物内血管丰富.脉络膜转移癌表现为眼底后极部不规则形、圆形灰黄色或灰白色扁平隆起肿物;B型超声和(或)CDFI检查可见后极部扁平形或表面不规则波浪形眼内占位性病变,内回声分布不均匀,瘤体内血流丰富.FFA和(或)联合ICGA检查可见瘤体上有特征性针尖样或点状强荧光;MRI检查可见T1 WI呈与玻璃体一致或稍高信号,T2 WI呈低信号.结论 葡萄膜转移癌以单眼单个病灶多见;大部分位于后极部脉络膜,呈扁平灰黄色隆起.FFA和(或)ICGA检查可见瘤体上有特征性针尖样或点状强荧光;B型超声和(或)CDFI可见扁平不规则实性占位,血流丰富;MRI检查T2 WI呈低信号.     

B型超声在挫伤性前房积血患者诊断中的应用

目的 探讨B型超声在挫伤性前房积血患者眼后段病变诊断中的意义.方法 对眼钝挫伤前房积血患者75例(78只眼)进行B型超声检查,观察玻璃体及眼底的改变,并对其检查结果进行分析.结果 B型超声显示:78只眼中未见明显异常10只眼(12.82％),玻璃体混浊37只眼(47.44％),黄斑区水肿10只眼(12.82％);玻璃体积血7只眼(8.97％);玻璃体后脱离6只眼(7.69％);视网膜或脉络膜出血5只眼(6.41％);黄斑区视网膜前出血2只眼(2.56％);视乳头水肿2只眼(2.56％);后巩膜破裂伴周边部视网膜脱离及玻璃体积血1只眼(1.28％).结论 B型超声是眼后段疾病的一种重要检查方法,特别是对于眼钝挫伤所致前房积血的患者更有意义.为疾病的早期诊断及治疗提供依据.     

30例非感染性后巩膜炎临床特征分析

目的总结非感染性后巩膜炎的临床特征,以期为临床上准确诊断、合理治疗提供依据。方法回顾性系列病例研究。收集2007年1月至2016年10月在中山大学中山眼科中心和温州医科大学附属第二医院就诊,经各项检查确诊为非感染性后巩膜炎的患者30例（40眼）,年龄（35.2±14.3）岁。所有病例都进行既往史回顾和病史分析,收集入选病例相关临床资料,包括最佳矫正视力（BCVA）、眼压、眼部常规检查和辅助检查等,并进行临床分析。结果10例双眼发病,33眼（83%）以眼痛伴视力下降为主诉就诊。就诊时10眼（25%）视力下降到0.1以下,13眼（32%）视力在0.1~0.6之间,17眼（43%）视力在0.6~1.2之间。眼压为（13.2±4.4）mmHg。在眼前段,22眼（55%）伴发前段巩膜炎,18眼（45%）有前葡萄膜炎症状;在眼后段,22眼（55%）发生视盘水肿,21眼（53%）存在视网膜静脉扩张,13眼（33%）黄斑部隆起脱离。另外发现渗出性视网膜脱离7眼（18%）,黄斑部星芒样渗出3眼（8%）,脉络膜脱离3眼（8%）,视网膜/脉络膜皱褶2眼（5%）,视网膜中央静脉阻塞3眼（8%）。所有患者眼部B超检查发现球壁弥漫性增厚,眼球壁后可见环形低回声,共同形成典型的"T"形征,球壁厚度为（2.21±0.85）mm。结论非感染性后巩膜炎临床表现多样,眼底可以有视盘水肿、静脉扩张、黄斑部渗出、黄斑部脱离隆起等体征,B超检查是后巩膜炎最特异性检查方法,可用于明确诊断。     

眼球内脉络膜转移癌的影像学诊断

目的 描述眼球内脉络膜转移癌的CT、MBI及B超表现,探讨其诊断、鉴别诊断价值.方法 回顾性分析16例(16只眼)经手术病理(11只眼)和临床(5只眼)证实的脉络膜转移癌病例,其中5只眼行CT扫描,9只眼行MRI检查,15只眼行B超检查,6只眼做了荧光素眼底血管造影(FFA).结果 4只眼CT增强扫描示弥漫性、不规则、边界不清、密度不均的扁平增生病变,3只眼增强后强化明显,1只眼呈脉络膜黑色素瘤表现,8只眼MRI T<,1>WI呈中高信号,T<,2>WI呈中低信号,1只眼T<,1>WI呈与玻璃体等信号,T<,2>WI呈略高信号,其中4只眼行增强T<,1>WI瘤体显著强化.B超检查13只眼呈实质不均质肿块占位,其中3只眼有挖空,2只眼呈实质较均质占位;9只眼显示高回声,5只眼中等回声,1只眼回声偏低.6只眼FFA均显示早期低荧光,静脉期点簇状高荧光,晚期呈细点状高荧光.结论 CT和MRI对脉络膜转移癌等眼球内病变均可作出定位的影像学诊断.MRI对脉络膜转移癌表现具有一定特征性.MRI+B超(+FFA)对脉络膜转移癌可得到较为准确的临床诊断.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

Contact Lens-associated Nocardial Necrotizing Scleritis

A 52 year-old, contact lens-wearing man presented with progressive right eye pain and redness for one month. He had been evaluated and treated for necrotizing scleritis by multiple eye care specialists prior to presentation. He underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis, including a culture. The culture revealed heavy growth of Nocardia asteroides complexes. The patient was treated with topical amikacin and oral Bactrim. Following several weeks of antibiotic treatment, the patient''s infection resolved completely, and his visual acuity returned to baseline status. Nocardia is a rare but potentially devastating cause of necrotizing scleritis that may affect contact lens wearers without an associated keratitis. Prompt recognition and early treatment with appropriate antimicrobial agents are critical to achieve a favorable outcome.     

Scleritis associated with sarcoidosis

Purpose: To review scleritis cases associated with sarcoidosis and to evaluate clinical features, medical treatment, and clinical course. Methods: Two cases of diffuse anterior scleritis and a nodular scleritis case associated with systemic sarcoidosis were evaluated. Scleritis was the first manifestation of sarcoidosis in two of the patients and the diagnosis of sarcoidosis was confirmed with a conjunctival biopsy. The third patient had the diagnosis of systemic sarcoidosis when she developed scleritis. Results: Based on the clinical and histological appearance, two patients presented with bilateral diffuse anterior scleritis and the third patient with an anterior nodular scleritis. One patient already had the diagnosis of systemic sarcoidosis at presentation, while ocular findings led to the diagnosis in the other two cases. Conjunctiva or skin biopsies revealed features compatible with the diagnosis of sarcoidosis. Scleritis attacks recurred in two patients. All patients responded well to systemic corticosteroid (prednisone) therapy. Conclusions: Scleritis associated with sarcoidosis has rarely been described and it may be the presenting sign of systemic sarcoidosis.     

大剂量甲基强的松龙静脉内冲击疗法治疗顽固性巩膜炎

评估甲基强的松龙对严重顽固性巩膜炎的疗效,为治疗严重顽固性巩膜炎寻找一种理想的方法。方法：１０例严重顽固性巩膜炎患者采用静脉内大剂量甲基强的松龙冲击疗法（５００ｍｇ／日）,连续３天为一疗程,可重复几个疗程,每疗程后间隔３～４天,并逐渐减量。结果：３～４疗程后,１０例患者其平均记分由治疗前的１２．２分降低到２．４分（Ｐ＜０．０１）,病情改善者３例,治愈者７例。副反应轻微。结论：静脉内大剂量甲基强的松龙冲击疗法治疗巩膜炎疗效高、作用快、副反应轻,是一种理想的治疗方法。值得进一步总结。     

A case of nodular posterior scleritis mimicking choroidal mass

The aim of this study is to report clinical and imaging findings, and treatment outcomes of a patient with nodular posterior scleritis. A 41-year-old woman was diagnosed as nodular posterior scleritis in the light of clinical and imaging findings. At first admission best corrected visual acuity was 20/50 in her right eye. Fundus examination revealed an amelanotic subretinal mass under the superior temporal arcade associated with subretinal fluid surrounding it. B-scan ultrasonography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography findings confirmed the diagnosis. As treatment, nepafenac eye drops 3 times a day, and flurbiprofen tablet 100 mg twice a day were prescribed. After 4 weeks of treatment, the ocular pain was relieved, BCVA improved to 20/20, and subretinal mass totally regressed. Although the diagnosis of nodular posterior scleritis may be confusing, it has to be kept in mind in patients with a subretinal/choroidal mass. Multimodal fundus imaging may be helpful in differential diagnosis. The condition is usually curable with non-steroidal anti-inflammatory drugs and/or systemic steroids.     

Successful Tocilizumab Treatment for Scleritis

ABSTRACT

Purpose: To present a rare case of scleritis associated with a prior diagnosis of giant cell arteritis (GCA) that was unresponsive to glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), methotrexate, and azathioprine, but reached and maintained a full remission with tocilizumab.

Observations: A 62-year-old Caucasian female presented with scleritis and headache. Four years earlier, the patient was diagnosed with GCA. Treatment with topical and systemic NSAIDs, prednisone and diverse disease-modifying antirheumatic drugsonly had a partial effect on the scleritis whilst the arthralgia and headaches increased. Despite the absence of laboratory evidence of active GCA, tocilizumab was started and the scleritis and headaches disappeared within several days. Prednisone could be fully tapered within 3 months and to date, 12 months after the start of tocilizumab, the patient has maintained a sustained remission.

Conclusions: Our patient demonstrates that tocilizumab might represent a therapeutic option for scleritis, and its further evaluation for this severe ocular disease is worthwhile.     

Successful infliximab treatment of posterior scleritis in a 13-year-old child refractory to other immunosuppressive therapy

Background Posterior scleritis is a potentially blinding inflammatory disorder rarely seen in children. Standard care consists of systemic administration of steroids and immunosuppressants such as methotrexate or ciclosporin A. We describe the case of a young girl suffering from therapy refractory posterior scleritis successfully treated with the tumor necrosis factor (TNF) inhibitor infliximab. Methods This study was an interventional case report. The medical chart of a 13-year-old child treated with infliximab (5 mg/kg, 10 applications at a 4–8 week interval) was reviewed for changes of visual acuity, fundoscopy, optic choherence tomography, ultrasound imaging, and adverse events. Results Infliximab therapy (5 mg/kg, 10 applications at a 4–8 week interval) led to a long-term remission of posterior scleritis after unsuccessful therapy with high dose prednisolone, methotrexate, and ciclosporin A. To date no side effects have been reported. Conclusions Administration of infliximab may be considered under appropriate circumstances to treat children with posterior scleritis.     

Scleral buckle induce orbital cellulitis and scleritis – A case report and literature review

We report a case of a young healthy patient who developed orbital cellulitis and scleritis after retinal detachment surgery that was repaired with a scleral buckling procedure. Once scleral implant infection occurs, orbital infection results requiring removal of the implant in all previous reported cases. However, our patient was treated with systemic antibiotic and steroids without the need for removal of the scleral buckle.     

Granulomatous anterior uveitis associated with bimatoprost

Purpose: To describe a previously unreported case of anterior granulomatous uveitis in a patient using bimatoprost. Methods: A 72-year-old woman with a long-standing history of anisometropic amblyopia and pseudoexfoliative glaucoma in the right eye started therapy with bimatoprost 0.03% once a day in the right eye. She had no previous history of ocular inflammation or ocular surgery. Her medical history was negative for systemic diseases associated with ocular inflammation. Results: After one week, the patient developed severe conjunctival injection, cells and flare, and numerous ‘mutton fat’ keratic precipitates in the right eye. Examination of the left eye revealed no evidence of inflammation. Bimatoprost was discontinued; no topical steroid therapy was started. Systemic investigations were normal. The inflammation resolved over two weeks, solely with the discontinuation of bimatoprost. Conclusions: Bimatoprost is a synthetic prostamide, chemically related to prostamide F. Prostamides are naturally occurring substances, biosynthesized from anandamide in a pathway that includes COX2. Even though anandamide has proven suggestive potential pro-inflammatory effects, the mechanism of induction of inflammation by bimatoprost remains uncertain and speculative. In our report, the onset of acute uveitis in a patient using bimatoprost, after a long-term and well-tolerated treatment with a prostaglandin analog, suggests a distinct potential pro-inflammatory action of prostamides. This can indirectly support the concept that the target receptor of bimatoprost is different, and that the mechanism of action of prostamides is pharmacologically unique.     

Clinical features, predisposing factors, and treatment outcomes of scleritis in the Korean population

Purpose

To evaluate the clinical features, associated factors, and treatment outcomes of scleritis in the Korean population.

Methods

Medical records were retrospectively reviewed for 94 eyes of 76 patients with scleritis. Clinical features of scleritis, including systemic disease, presence of microorganisms, serologic markers, history of previous ocular surgery, and use of immunosuppressants were investigated and compared amongst the subtypes of scleritis. Treatment outcomes were evaluated using best corrected visual acuity (BCVA) and time to scleritis remission.

Results

Nodular scleritis was the most common form observed, followed by necrotizing scleritis with inflammation, diffuse scleritis, and necrotizing scleritis without inflammation, respectively. A total of 16 of 76 patients (21.1%) had connective tissue diseases. Eleven cases (14.5%) had infectious scleritis, of which bacteria (54.5%) and fungi (45.5%) were the causative microorganisms. Thirty-three patients (43.4%) had previous ocular surgery, mostly pterygium excision. Notably, a history of pterygium excision was significantly associated with development of necrotizing and infectious scleritis (odds ratio [OR], 399 and 10.1; p < 0.001 and 0.002, respectively). In addition, patients with necrotizing scleritis were more likely to have infectious scleritis (OR, 11.7; p = 0.001). BCVA after treatment and time to remission also showed significant differences among the different scleritis subtypes. Systemic immunosuppression was required in addition to steroids for treating diffuse and necrotizing scleritis.

Conclusions

Careful taking of patient history including previous pterygium excision should be performed, especially in patients with necrotizing and infectious scleritis. In addition, evaluation of microbiological infection can be crucial for patients with necrotizing scleritis and history of pterygium excision.