原发性眼内淋巴瘤13例

目的 观察原发性眼内淋巴瘤(PIOL)的临床表现.方法 回顾分析临床及病理检查确诊的13例PIOL患者24只眼的临床资料,着重分析其眼部表现.除常规眼科检查外,屈光间质清楚者同时行荧光素眼底血管造影(FFA)和光相干断层扫描(OCT)检查.所有患者行诊断性玻璃体手术,其中经玻璃体细胞病理分析确诊11例,视网膜活检确诊1例,后期发生神经系统症状神经科活检确诊1例.结果 患者中男性5例,女性8例;平均年龄(55.7±12.6)岁.单眼发病2例,双眼发病11例.中枢神经系统淋巴瘤合并PIOL者9例16只眼,占患眼的66.7％;单纯PIOL者4例8只眼,占患眼的33.3％.患者视力为光感～1.0.孤立性玻璃体炎型PIOL 14只眼,占58.3％;玻璃体视网膜型PIOL 10只眼,占41.7％.FFA检查发现,孤立性玻璃体炎型PIOL无异常表现;玻璃体视网膜型PIOL均有广泛的视网膜色素上皮(RPE)病变.OCT检查发现,孤立性玻璃体炎型PIOL无异常表现;玻璃体视网膜型PIOL的RPE和Bruch膜之间呈强反射.结论 PIOL临床表现多种多样,以双眼发病居多;玻璃体视网膜型存在广泛的RPE病变.     

眼球恶性淋巴瘤的诊断及治疗

眼球恶性淋巴瘤是淋巴瘤的一种特殊类型，原发或继发于葡萄膜，视网膜及玻璃体，迄今国内外仅有一百余例报告。该病在眼部的临床表现多种多样，主要累 及葡萄膜，其次累及视网膜及玻璃体，与中枢神经系统淋巴瘤密切相关，易误诊为慢性葡萄膜炎、视网膜管炎、急性视网膜坏死等多种眼部疾病而延误早期治疗时机。     

伪装综合征14例临床诊治分析

目的 探讨伪装综合征的临床表现特征及诊断线索,减少临床误诊误治.方法 回顾分析中山大学中山眼科中心在2004年1月至2010年4月期间收治的表现为伪装综合征的14例患者,包括视网膜母细胞瘤12例,眼内转移癌1例,眼内淋巴瘤1例,对这些病例资料进行整理分析.结果 12例视网膜母细胞瘤患者年龄均大于5岁,其中9例误诊为葡萄膜炎,3例初诊时表现类似葡萄膜炎,临床上多呈现为“羊脂状KP”,“前房积脓”,虹膜表面有大小不一,灰白球状或雪花状沉着物,玻璃体灰白雪球状或小片状混浊物漂动等,却很少以白瞳症就诊.1例眼内转移癌误诊为青光眼、葡萄膜炎,1例眼内非霍奇金淋巴瘤误诊为睫状体炎,两例患者中前者前房内的灰白颗粒状、球状或片状沉着物不伴有明显的眼内炎症反应,后者有明显的虹膜局限性肿瘤浸润增厚,不同于真正的葡萄膜炎.结论 部分视网膜母细胞瘤、眼内转移癌和眼内非霍奇金淋巴瘤等眼内恶性肿瘤患者可表现为类似葡萄膜炎症,容易误诊,应引起重视.     

眼内液检查在儿童葡萄膜炎诊断中的应用

目的 探讨眼内液检查在儿童葡萄膜炎诊断中的应用.方法 回顾分析18 例接受前房或玻璃体液检查的儿童葡萄膜炎的临床特征,并结合眼内液检查作出最后诊断.对患者进行了最佳矫正视力、眼压、B超、超声生物显微镜、间接眼底镜以及RetCam数字视网膜照相机检查.对疑为犬弓蛔虫病例做血清和眼内液酶联免疫吸附测定（enzyme-linked immunosorbent assay, ELISA）.结果 最终诊断为眼犬弓蛔虫病的患者有12 例,中间葡萄膜炎的5 例.眼犬弓蛔虫病多单眼发病,玻璃体条索和视网膜肉芽肿是其典型表现,眼内液和（或）血清ELISA 呈阳性,细胞学检查58.3%（7/12）可见嗜酸性细胞.中间葡萄膜炎双眼发病多见,常发生虹膜后粘连、白内障等并发症.结论 犬弓蛔虫病在本地区并不少见,诊断性玻璃体手术切除混浊玻璃体后能更清楚地了解眼底情况,取得眼内液做ELISA和病理检查能最终明确诊断;同时行玻璃体手术也是本病的有效治疗方法.     

眼球恶性淋巴瘤的诊断及治疗

眼球恶性淋巴瘤是淋巴瘤的一种特殊类型，原发或继发于葡萄膜、视网膜及玻璃体，迄今国内外仅有一百余例报告。该病在眼部的临床表现多种多样，主要果及葡萄膜，其次累及视网膜及玻璃体，与中枢神经系统淋巴瘤密切相关，易误诊为慢性葡萄膜炎、视网膜血管炎、急性视网膜坏死等多种眼部疾病而延误早期治疗时机。其原因与该病发病倒数少，认识不足有关，故将历年来国内外有关报告，对该病的临床表现、诊断及鉴别诊断、治疗及预后等几个方面进行综述。     

以后葡萄膜炎为首发症状隐性梅毒的临床分析

背景 葡萄膜炎是梅毒在眼部的常见表现,眼科医师对梅毒性后葡萄膜炎的认识尚显不足,临床上易造成漏诊或误诊而延误治疗. 目的 探讨以后葡萄膜炎为首发症状的隐性梅毒的临床特征及其治疗效果.方法 采用回顾性临床病例分析方法,收集2011年9月至2013年1月在扬州大学临床医学院眼科参照杨培增的标准并结合临床及血清学检查确诊的12例19眼以后葡萄膜炎为首发症状的隐性梅毒患者的临床资料,描述其眼部临床特征,评估其治疗与预后的关系.所有患者均以急性或慢性视力下降起病,就诊时均否认梅毒史.7例患者为双眼发病,5例患者单眼发病.结果 三面镜下所有患眼均可见玻璃体尘状及灰白色浮游细胞,视盘显著充血和肿胀者2眼,视盘轻度充血者10眼,后极部视网膜有黄白色病灶者7眼,病变区视网膜点状出血者1眼,眼底改变不明显但视网膜色泽变暗者3眼.荧光素眼底血管造影（FFA）检查显示,10眼造影早期出现斑点状弱的背景荧光,18眼造影中期表现出视网膜血管管壁的荧光素渗漏及着染,造影晚期19眼均可见视盘荧光素着染或强荧光,6眼可见黄斑区视网膜色素上皮荧光素积存,11眼出现黄斑区视网膜血管扩张及渗漏.所有患者快速血浆反应素试验及梅毒螺旋体血凝试验结果均为阳性.患者确诊后即按神经梅毒的治疗方案进行驱梅治疗,包括青霉素类抗生素的全身应用,病情严重者辅以小剂量糖皮质激素短期口服治疗,17眼视力完全恢复,2眼病程较长者视力部分恢复,眼底病变消退.结论 对于病因不明的后葡萄膜炎患者要警惕梅毒所致的后葡萄膜炎,并进行梅毒血清学检查.早期诊断和正规治疗对预后至关重要.     

FFA与OCT检查在葡萄膜炎诊疗中的价值

目的:研究眼底荧光血管造影(FFA)和光学相干断层扫描(OCT)检查在葡萄膜炎诊疗中的临床影像学价值.方法:选取2014-04/2016-04在本院接受治疗的葡萄膜炎患者共140例244眼,其中双眼发病患者104例208眼,单眼发病患者36例36眼,患者均经过病史询问、裂隙灯、检眼镜、眼B超等检查确诊是葡萄膜炎.依据葡萄膜炎的解剖部位分成:前葡萄膜炎患者72例132眼,中间葡萄膜炎患者24例48眼,后葡萄膜炎患者28例40眼,全葡萄膜炎患者16例24眼.对以上患者行FFA与OCT检查,评估患者眼底的病变情况.结果:前葡萄膜炎的检出率为46.2%,中间葡萄膜炎的检出率为43.8%,后葡萄膜炎的检出率为45.0%,全葡萄膜炎的检出率为54.2%,前葡萄膜炎患者出现的眼底炎症性病变多位于眼底周边部,后葡萄膜炎和全葡萄膜炎患者的眼底炎症主要位于后极部位.结论:FFA客观反映了葡萄膜炎对视网膜产生的影响,帮助了解患者脉络膜、视神经和视网膜的病变程度,从而使用合适的方法进行治疗;OCT则为患者提供了客观、直接的评价手段.     

Schwartz综合征早期临床特点、漏误诊原因及治疗

目的 探讨Schwartz综合征的临床特征,漏误诊原因和手术方式的选择.方法 Schwartz综合征8例.详细询问病史,双眼裂隙灯显微镜及检查镜检查,观察治疗经过和手术效果.分析诊断的一致性及漏诊、误诊原因.结果 患者18～42岁,均单眼受累,6例有外伤史,首诊误诊为青光眼4例、青睫综合征1例、葡萄膜炎2例.巩膜扣带术治愈4例,玻璃体视网膜联合手术治愈2例,2次巩膜扣带术治愈1例,2次玻璃体视网膜联合手术治愈1例.结论 Schwartz综合征是一种伴有高眼压和葡萄膜炎反应的孔源性视网膜脱离,临床上常误诊为青光眼、葡萄膜炎、青睫综合征而延误治疗.缺乏对眼底的详细检查和对该病临床特征的认识是误诊主要原因.根据玻璃体视网膜增生情况选择巩膜扣带术或玻璃体切除术,视网膜复位后高眼压和葡萄膜炎反应自然好转.     

Vogt-小柳-原田病的临床特点和治疗分析

目的探讨Vogt-小柳-原田病(Vogt-Koyanagi-Harada,VKH)的临床特点、治疗和预后等问题。方法连续收集近两年间在我院就诊的VKH患者45例,对其眼部表现、全身症状、荧光素眼底血管造影(fundus fluo-rescein angiography,FFA)和治疗进行回顾性分析。结果45例患者均为双眼发病,男女比例是1:1.4,平均年龄39.3岁。发病前有前驱症状者37例(82.2%),主要为头痛。就诊时有眼外症状和体征者39例(86.7%),包括中枢神经系统异常、听力障碍、白发脱发和白癜风。发病后2周内就诊者11例,表现为双眼脉络膜炎、视盘及视网膜水肿;发病后2周至3个月内就诊者24例,主要表现为非肉芽肿性前葡萄膜炎、后葡萄膜炎和浆液性视网膜脱离;复发患者(病程3个月以上)10例,主要表现为肉芽肿性前葡萄膜炎、晚霞状眼底改变和Dalen-Fuchs结节。FFA检查表现为斑驳状高荧光、视盘染色和多湖样染料积存。所有患者给予大剂量糖皮质激素治疗,疗程为3～18个月。初发组94.3%患者葡萄膜炎完全控制,视力显著提高。10例复发者中炎症完全控制7例(70%),视力有不同程度提高。结论前驱症状、临床病程、眼外表现及FFA等有助于VKH的诊断,早期给予大剂量糖皮质激素治疗,绝大部分患者可控制炎症,改善视力。     

慢性全葡萄膜炎并发非孔源性视网膜脱离的手术治疗

目的 探讨慢性葡萄膜炎并发非孔源性视网膜脱离的手术方式、效果.方法 回顾性分析玻璃体切除联合硅油填充术治疗的慢性全葡萄膜炎并发非孔源性视网膜脱离11例(11眼).结果 硅油填充术后11眼均有明显全葡萄膜炎反应,7眼瞳孔膜闭,形成瞳孔阻滞性青光眼,其余无眼压升高,视网膜复位好.硅油取出后,除1眼因复诊不及时致青光眼绝对期未能取出硅油外,硅油取出后10眼均无葡萄膜炎复发,视网膜复位良好.结论 玻璃体切除联合硅油填充术治疗的慢性葡萄膜炎并发非孔源性视网膜脱离复位效果良好.     

Endogenous uveitis during pregnancy--a report of 4 cases

PURPOSE: To estimate the influence of pregnancy on the clinical course of endogenous uveitis. MATERIAL AND METHODS: Four pregnant women (6 eyes) aged 16-21 yrs with uveitis of unknown etiology were observed. In two cases uveitis was bilateral while other two patients developed unilateral intraocular inflammation. At the time when the pregnancy was diagnosed systemic steroids were discontinued. Ophthalmic examination was performed every 1-2 months and then 3-8 months after delivery. RESULTS: In all cases, before pregnancy, the active stage of uveitis was observed; vitreous flare and vitreous cells were present in all cases (6 eyes). Iritis was present in one patient (1 eye), inflammatory chorioretinal lesions in 2 cases (3 eyes), while retinal vasculitis was observed in one case (1 eye). During pregnancy as well as within 3-8 months of follow-up after delivery, neither progression nor recurrences of uveitis were observed. In all patients gradual, total regression of intraocular inflammation with the improvement of visual acuity in 3 cases were noted. CONCLUSIONS: Our observations can suggest positive influence of pregnancy on uveitis activity.     

急性视网膜坏死综合征误诊分析5例

目的:急性视网膜坏死综合征是一种以中到重度葡萄膜炎、血管炎以及血管闭塞性视网膜坏死为特征的严重眼病,其早期诊断比较困难,有的甚至在行玻璃体视网膜手术过程中才被确诊。分析临床上急性视网膜坏死综合征误诊的原因,总结早期诊断的经验。方法:回顾我院5例未能及时诊断的急性视网膜坏死综合征病例的临床特点,诊治经过及最终预后,并分析误诊原因。结果:5例病例中,1例被误诊为虹膜睫状体炎,2例误诊为葡萄膜炎并视网膜脱离,1例误诊为视网膜中央动脉阻塞,1例被误诊为出血性视网膜血管炎。这些疾病在临床诊断过程中有必要考虑与急性视网膜坏死鉴别。结论:急性视网膜坏死综合征临床表现变异较大,有些表现不典型,临床工作中应充分认识此疾病。     

玻璃体手术治疗中间葡萄膜炎玻璃体视网膜并发症的临床效果

目的 探讨玻璃体手术治疗中间葡萄膜炎玻璃体视网膜并发症的临床效果.方法 为系列病例研究.选择16例(16只眼)并发玻璃体视网膜疾病的中间葡萄膜炎患者进行玻璃体手术治疗.术后随访5～32个月,平均(14.25±7.90)个月.随访期间观察患者视力、术后并发症及中间葡萄膜炎的复发情况.结果 16例(16只眼)患者中,有4例分别患有肺结核、多发性硬化、Beheet综合征及风湿性关节炎等全身性疾病,其余12例无系统性疾病.术前所有患者均有糖皮质激素治疗史,使用时间为6～16个月,平均(9.94±2.67)个月.玻璃体视网膜并发症包括重度玻璃体混浊伴机化5只眼,牵引性视网膜脱离6只眼,孔源性视网膜脱离1只眼,玻璃体积血2只眼,黄斑前膜伴玻璃体机化2只眼,所有患眼均出现周边部视网膜新生血管.术后并发白内障3只眼,牵引性视网膜脱离1只眼.术后4例患者需长期服用糖皮质激素或联合免疫抑制剂治疗.术后视力提高或保持不变14只眼,视力下降2只眼,与术前视力比较差异有统计学意义(x2=4.923,P＜0.05).术后未见中间葡萄膜炎复发者.结论 对严重或药物控制不佳而出现玻璃体视网膜并发症的中间葡萄膜炎患者采用经平坦部的玻璃体手术治疗,可以明显改善患者视力,减少长期使用免疫抑制剂治疗的不良反应.     

梅毒性葡萄膜炎3例

目的：评估梅毒性葡萄膜炎患者的临床表现和视力. 方法：梅毒性葡萄膜炎患者3例在USM医院接受治疗. 结果：患者3例被诊断为继发性梅毒性葡萄膜炎,这3例患者患病之前均不知道患有梅毒,但他们有明确的乱交史.并且每个月都伴有逐步的视力下降.其中两人伴有发热、跟痛、眼前悬浮物.视力从6/12到手动.所有患者均出现前葡萄膜炎,玻璃体炎和视神经炎.第一例患者出现了多灶性脉络膜视网膜炎,并伴有渗出性视网膜脱离.第二例患者出现渗出性视网膜脱离,而第三例患者仅出现了脉络膜视网膜炎.所有患者每周注射苄青霉素2.4MU,共4wk,其中2例患者口服多西霉素200mg 2次/d,共3mo.治疗效果良好,其中2例患者有显著的视力上升,分别从6/120到6/21和6/12到6/6.其中较严重的1例患者出现逆转录酶为阳性. 结论：眼梅毒作为非肉芽肿性的炎症与渗出性视网膜脱离有关.治疗后虽然视力恢复比较缓慢,但普遍有良好的效果.     

原发性玻璃体视网膜淋巴瘤患眼光相干断层扫描图像特征

目的:观察原发性玻璃体视网膜淋巴瘤（PVRL）患眼光相干断层扫描（OCT）图像特征。方法:回顾性临床研究。2016年9月至2019年10月于北京同仁医院眼科经玻璃体病理学检查确诊为PVRL的19例患者32只眼纳入研究。其中,男性7例,女性12例;中位年龄56岁;出现症状至最终平均确诊时间（6.1±3.8）个月。首诊诊断...     

青光眼睫状体炎综合征误诊误治临床分析

目的探讨青光眼睫状体炎综合征误诊误治的原因。方法收集1999年8月~2004年7月我院门诊确诊的25例(25只眼)青光眼睫状体炎综合征患者,总结患者在外院误诊误治情况并进行回顾性临床分析。结果25例(25只眼)青光眼睫状体炎综合征在外院被误诊原发性青光眼14例(14只眼),占56%;虹膜睫状体炎7例(7只眼),占28%;疱疹性葡萄膜炎2例(2只眼),占8%;中间葡萄膜炎1例(1只眼),占4%;Fuchs虹膜异色性葡萄膜炎1例(1只眼),占4%。在治疗方面均与青光眼睫状体炎综合征治疗原则不相符合,其中9例(36%)在外院施行了抗青光眼滤过手术。结论青光眼睫状体炎综合征在临床上误诊误治普遍存在,首先它容易被误诊为原发性青光眼和虹膜睫状体炎,其次为疱疹性葡萄膜炎、中间葡萄膜炎和Fuchs虹膜异色性葡萄膜炎。应重视青光眼睫状体炎综合征的诊断与治疗,注意与上述眼病鉴别,减少对青光眼睫状体炎综合征的误诊误治。     

Recurrent retinal detachment more than 1 year after reattachment

PURPOSE: Little information exists regarding recurrent retinal detachment after 1 or more years of complete retinal reattachment. To better understand this uncommon problem, we evaluated late recurrent retinal detachments in relation to the contemporary classification of proliferative vitreoretinopathy (PVR). DESIGN: Retrospective consecutive noncomparative case series. PARTICIPANTS: Nine patients (10 eyes) with late recurrent retinal detachment after 1 or more years of complete reattachment. METHODS: We retrospectively analyzed the clinical and operative records of one surgeon over a 9-year period to identify late recurrent retinal detachments that occurred 1 or more years after complete retinal reattachment. The study group was derived from a total of 453 consecutive cases of rhegmatogenous retinal detachment repair not associated with proliferative diabetic retinopathy, uveitis, or penetrating ocular trauma. MAIN OUTCOME MEASURES: Late recurrent retinal detachments after 1 or more years of complete retinal reattachment. RESULTS: The study group consisted of 10 eyes (2.2% of total) in nine patients. Redetachment occurred from 12 to 126 months (average, 46.8 months) after the initial detachment surgery. Late recurrent retinal detachments were associated with new retinal breaks (five eyes), reopening of old breaks (three eyes), or both (two eyes). In all, 13 open breaks were identified, nine of which were on or anterior to the scleral buckle. Eight eyes had grade C PVR, including four eyes with anterior PVR, three eyes with posterior PVR, and one eye with both anterior and posterior PVR. The retina was reattached after additional vitreoretinal surgery in eight eyes of seven patients; two patients (two eyes) declined reoperation. Visual acuity improved in seven of eight eyes after repair of the late recurrent retinal detachment. Postoperative follow-up after late recurrent detachment repair ranged from 69 to 140 months (average, 101.7 months, or 8.5 years). CONCLUSIONS: Vitreous base traction seems to be an important factor in late recurrent retinal detachments occurring 1 or more years after complete retinal reattachment, and the associated PVR was probably a secondary phenomenon and not a causative factor in most cases. Reoperation for such late recurrent retinal detachments can successfully reattach the retina and improve visual acuity in most cases.     

Serum anti-retinal antibodies and intensity of endogenous posterior uveitis

PURPOSE: To analyse the correlation between the anti-retinal antibodies (ARA) and intensity of intraocular inflammation in patients with endogenous posterior uveitis. MATERIAL AND METHODS: 50 patients--29 women (58%) and 21 men (42%) in age 15-70 yrs with idiopathic posterior uveitis were examined. Intraocular inflammation intensity was scored on standard uveitis grading system prepared by BenEzra et al. In all cases the ARA were determined by indirect immunofluorescence test on normal monkey retina as a substrate and FITC-labelled goat's anti-human IgA, G, M serum (Euroimmun-Germany). The control serum was obtained from 50 blood donors: 20 women (40%) and 30 men (60%) in age 15-68 yrs. RESULTS: The statistical analysis showed a correlation between the ARA serum levels and intraocular inflammation intensity. High correlation was found in first control between serum ARA level and the degree of vitreous inflammation and the presence of fresh vessels sheathing, characteristic for retinal vasculitis. In next three controls, this correlation was still present, but only in a case of vitreous changes. And at the end of observation no correlation was found, neither between serum ARA levels and the activity of vitreous inflammation, nor between the ARA levels and retinal vasculitis intensity. CONCLUSIONS: The assessment of serum ARA in patients with idiopathic posterior uveitis can act as an indicator for intraocular inflammation intensity and can reflect the retinal autoimmunity.     

Syphilitic uveitis: report of 3 cases

AIM: To evaluate the clinical manifestations and visual outcome of syphilitic uveitis patients. METHODS: Case series of three patients with syphilitic uveitis who were managed in Hospital USM. RESULTS: Three patients were diagnosed to have uveitis secondary to Syphilis. All three patients were not known to have syphilis prior to presentation but have positive history of sexual promiscuity. All patients presented with progressive blurring of vision for average of one-month duration. Two of them have association with fever, ocular pain and floaters. Visual acuity at presentation ranges from 6/12 to hand movement. Mild anterior uveitis (non-granulomatous), vitritis and papillitis were presence in all the patients. First patient has multifocal chorioretinitis with exudative retinal detachment. The second patient presented with exudative retinal detachment while the third patient has chorioretinitis only. All the patients were treated with intramuscular benzyl-penicillin 2.4 MU weekly for 4 weeks and two of them received oral doxycycline 200mg twice daily for 3 months. The uveitis responded well to the treatment and two of them showed dramatic visual improvement from 6/120 to 6/21 and 6/12 to 6/6. The one with worse outcome was confirmed to have positive retroviral. CONCLUSION: Ocular syphilis presented here as non- granulomatous inflammation associated with exudative retinal detachment. Final visual outcome is generally good despite slow improvement after treatment.