儿童葡萄膜炎临床分析

目的 分析儿童葡萄膜炎的临床特点、治疗效果、视力预后以及相关的全身疾病.方法 采用回顾性病例分析方法,收集近4年间在天津市眼科医院诊治的16周岁及以下的儿童葡萄膜炎患者106例(165只眼),通过详细询问病史、眼部或全身检查,确定葡萄膜炎类型;分析其治疗效果、并发症发生情况和视力预后.结果 在106例患者中,男45例,女61例(1:1.4);平均发病年龄为(10.9±3.3)岁.急性发病18例(17.0%),慢性发病37例(34.9%),反复发作者51例(48.1%).单眼发病47例,双眼发病59例.其中前葡萄膜炎52例(49.1%),中间葡萄膜炎31例(29.2%)、全葡萄膜炎15例(14.2%)和后匍萄膜炎8例(7.5%).感染性葡萄膜炎15例(14.2%),特发性或免疫相关性炎症91例(85.8%).根据病因分类,特发性前葡萄膜炎36例(34.0%),特发性中间葡萄膜炎31例(29.2%),特发性全葡萄膜炎13例(12.3%),合并幼年型关节炎10例(9.4%)和病毒性前葡萄膜炎5例(4.7%).42例患儿58只跟(35.2%)出现眼部并发症,主要有虹膜后粘连(21.8%)、并发白内障(17.0%)、继发青光眼(9.7%)、角膜带状变性(9.7%)和黄斑囊样水肿(8.5%).末次随访矫正视力低于0.5者45只眼(27.3%),低于0.1者16只眼(9.7%).结论 前葡萄膜炎是儿童时期常见的葡萄膜炎类型,其次为中间葡萄膜炎和全葡萄膜炎,后部葡萄膜炎较少见.多数患者表现为慢性特发性炎症,感染性葡萄膜炎较少见.儿童葡萄膜炎引发的各类并发症是致盲的主要原因.     

不同类型葡萄膜炎患者致病原因分析

目的：分析不同类型葡萄膜炎患者的致病原因。
　　方法：选取2012-06/2015-06在我院进行诊治的葡萄膜炎患者60例120眼,所有患者均由同一葡萄膜炎专科医生,按照统一诊疗规范进行检查。依据国际葡萄膜炎研究定制的标准,将其分为：前葡萄膜炎、中葡萄膜炎、后葡萄膜炎、全葡萄膜炎。观察患者的年龄、性别、葡萄膜炎类型及患病原因。
　　结果：通过对患者的病因及临床类型分析,所选葡萄膜炎患者主要特发性26眼(21.7%)、VKH 综合征18眼(15.0%)、HLA-B27相关性14眼(11.7%)、病毒性12眼(10.0%)、Fuchs 综合征8眼(6.7%)、Behcet 病8眼(6.7%)、糖尿病6眼(5.0%)、梅毒6眼(5.0%)、青光眼睫状体综合症6眼(5.0%)、幼年型慢性关节炎4眼(3.3%)、交感性眼炎4眼(3.3%)、外伤性2眼(1.7%)、类肉瘤2眼(1.7%)、眼内炎2眼(1.7%)、其他2眼(1.7%);通过对不同葡萄膜炎的病因观察,前葡萄膜炎病因主要有特发性病例,其次是HLA-B27相关性、病毒性;全葡萄膜炎的治病原因中以VKH综合征、特发性病例和Behcet病为主;后葡萄膜炎主要是特发性病例,其次是病毒性感染;中间葡萄膜炎以特发性病例为主。
　　结论：通过对临床患者观察分析,葡萄膜炎患者男性多于女性;特发性、VKH 综合征、病毒性伴发的葡萄膜炎和Behcet病是其常见的葡萄膜炎类型。     

急性前葡萄膜炎215例临床分析

目的:分析并探讨急性前葡萄膜炎的病因、治疗效果、复发率及预后等问题。方法:对近5a在奉化人民医院眼科诊治的215例急性前葡萄膜炎进行详细病史采集、临床检查及各项辅助检查,观察其治疗效果及复发情况,对其病因、预后及复发率进行分析。结果:查找到病因者85例(39.5%),病因位列前三的是外伤或手术后急性前葡萄膜炎、病毒性前葡萄膜炎及青光眼睫状体炎综合征。治疗后最佳矫正视力≥1.0者153例(71.2%),0.5≤视力<1.0者55例(25.6%),0.3≤视力<0.5者4例(1.9%),0.05≤视力<0.3者2例(0.9%),视力<0.05者1例(0.5%)。所有病例在6mo以上的随访过程中,4～6mo内复发者4例(1.9%),7～12mo复发者7例(3.2%),13～24mo复发者10例(4.7%),25～60mo复发者3例(1.4%)。结论:急性前葡萄膜炎病因复杂,多为特发性,治疗后视力预后较好,但复发率高,反复发作影响视力,故应了解其复发特点,重预防,早治疗。     

葡萄膜炎的临床类型及病因探讨

目的 探讨葡萄膜炎的临床类型、病因及其发病年龄和性别构成。 方法 对1996年1月至2001年12月，于中山眼科中心葡萄膜炎专科就诊的葡萄膜炎患者的资料进行回顾性分析，特别是按照解剖位置分类并结合病因分类方法，对葡萄膜炎的病因、类型进行探讨，并就发病的年龄和性别等因素进行分析讨论。 结果 各种类型葡萄膜炎患者共计1 214例，男698人，女516人，平均发病年龄34-43岁。其中前葡萄膜炎546例，占所有患者的44.98%；全葡萄膜炎530例，占43.66%；中间葡萄膜炎78例，占6.43%；后葡萄膜炎60例，占4.94%。能够确定病因或归于特定类型的患者共703例，占57.91%，其余为特发性患者511例。前葡萄膜炎中特发性患者最多，共316例占57.88%，其次为Fuchs综合征85例和关节强直性脊椎炎45例；全葡萄膜炎中最常见的类型为BehÇet病218例(41.13%)和Vogt-小柳原田综合征196例(36.98%)；中间和后葡萄膜炎均为特发性。 结论 葡萄膜炎多发于青壮年；男性患者整体上稍多于女性；常见类型为特发性前葡萄膜炎、BehÇet小柳原田综合征等；解剖位置结合病因进行分类是较为合理的葡萄膜炎分类方法。 (中华眼底病杂志, 2002, 18: 253-255)     

前葡萄膜炎156例病因分析

目的对156例(156眼)单眼前葡萄膜炎患者的临床资料进行分析,探讨其病因特点。方法根据病史、临床表现、合并全身疾病,采用实验室检查等辅助手段查找病因。结果 156例患者的主要病因为外伤和人工晶状体等手术各20例,分别占12·82%;单纯疱疹病毒性角膜炎并发前葡萄膜炎19例,占12·18%;其后依次是风湿性关节炎、糖尿病、Fuch综合征等;未找到病因者59例,占37.82%。结论前葡萄膜炎病因复杂,对此类患者应详细行眼部检查,并借助全身检查和辅助检查积极查找病因,及时诊治,避免严重并发症发生。     

Vogt-Koyanagi-Harada综合征的临床表现及诊断

目的 探讨Vogt-Koyanagi-Harada(VKH)综合征患者的临床特征.盲目原因及诊断等有关问题.方法 对在1996年1月至2000年12月间就诊资料完整的157例VKH综合征患者进行回顾性分析,并对裂隙灯,眼底镜,三面镜,荧光素眼底血管造影(fundus fluorescein angiography,FFA),吲哚青绿血管造影(indocyanine green angiography,ICGA)及人类白细胞抗原(HLA)分型等检查结果进行分析.结果 VKH综合征最常见的前驱症状为头痛(102例,73.5%),双眼同时患病118例(80.8%);后葡萄膜炎期眼部主要表现为脉络膜炎,视乳头及附近视网膜水肿(100.0%);前葡萄膜炎反复发作期眼部表现为复发性肉芽肿性前葡萄膜炎(128例,98.4%),晚霞状眼底改变(95.8%)及Dalen-Fuchs结节(71.2%),后葡萄膜炎期,前葡萄膜受累期及前葡萄膜炎反复发作期导致盲目的主要原因分别为视乳头炎,视网膜脱离及并发性白内障;毛发变白(36.3%)及脱发(35.0%)是最常见的眼外表现;炎症活动期FFA典型表现为斑驳状高荧光,ICGA发现脉络膜血管扩张,通透性增高等改变;VKH综合征患者HLA-DR4及HLA-DRw53的阳性率(54.9%及71.8%)显著高于正常对照组(14.7%及38.2%).结论 VKH综合征患者在后葡萄膜炎期眼部典型表现为双侧脉络膜炎,视乳头炎或神经视网膜炎,随后出现以反复发作的肉芽肿性前葡萄膜炎为特征的全葡萄膜炎.眼外症状及相关的辅助检查包括FFA,ICGA及HLA分型等有助于VKH综合征的诊断。     

全葡萄膜炎的临床特征及诊治分析

目的 探讨全葡萄膜炎的临床特征及治疗.方法 回顾分析2011年8月至2013年6月我院眼科诊断为全葡萄膜炎并接受住院治疗患者的病例资料.结果 26例（32只眼）全葡萄膜炎患者中,男性17例,女性9例,男女比例为1.89：1,平均年龄为（40.1±12.1）岁.其中特发性10例（42.1%）,小柳原田综合征4例（15.4%）,交感性眼炎3例（11.5%）,病毒性3例（11.5%）,Behcet病2例（7.7%）,急性视网膜坏死综合征2例（7.7%）,强直性脊柱炎1例（3.85%）和尘肺伴肺结核1例（3.85%）.经局部糖皮质激素、非甾体药物、睫状肌麻痹剂,全身糖皮质激素甚至免疫抑制剂,以及抗病毒及抗结核,多数全葡萄膜炎患者视力得到改善.结论 全葡萄膜炎对视力损害严重,治疗周期较长,不及时、合理的治疗常常导致盲目的 发生,短期的住院治疗仅使患者炎症得以部分控制,炎症的彻底控制仍需较长时间的药物维持;同时全葡萄膜炎的病因复杂,给眼科医生正确诊断和治疗带来了困难.     

中国葡萄膜炎的临床类型及病因学(英文)

目的 探讨及分析中国葡萄膜炎患者的临床及病因分型 方法 回顾性分析了中山眼科中心葡萄膜炎诊室接诊的1200例(男性690例,女性510例)葡萄膜炎患者 根据解剖特点进行了临床分型 从病史,临床表现及实验室检查方面进行了病因分型 结果在1200例中,601例(50.1％)属前葡萄膜炎,454例(37.8％)属全葡萄膜炎,134例(11.2％)属中间葡萄膜炎,11例(0.9％)属后葡萄膜炎 病因查明者有616例(51.4％),包括伏格特— 小柳—原田综合瘙(252例,21.0％)。风湿性关节炎(156例,13.0％),白塞氏病(78例,6.5％),单纯疱疹病毒感染(40例,3.3％),富克斯异色性睫状体炎(25例,2.1％)及其它,结论 前葡萄膜炎,伏格物—小柳—原田综合症前葡萄膜炎,风湿性关节炎前葡萄膜炎及白塞氏病前葡萄膜炎分别是中国最见的解剖或病因类型。     

病毒性前葡萄膜炎的临床研究进展

病毒性前葡萄膜炎是临床最常见的葡萄膜炎之一,是重要的致盲性疾病。其病因复杂、机制不清,临床表现多样化,易与其他类型葡萄膜炎混淆,较难及时进行病因诊断;治疗上,由于较难针对病因治疗,常常存在不规范治疗,导致病情迁延反复。本文就疱疹病毒性、巨细胞病毒性及风疹病毒性前葡萄膜炎的临床表现、诊断及治疗进展进行综述,比较了巨细胞病毒、风疹病毒性前葡萄膜炎与疱疹病毒性前葡萄膜炎的临床特点,归纳了病毒性前葡萄膜炎的诊疗思路。     

强直性脊柱炎伴葡萄膜炎的临床特征及治疗

目的:探讨强直性脊柱炎(ankylosing spondylitis,AS)伴发葡萄膜炎的临床表现和诊治.方法:收集我院自2012-08/2015-08就诊并最终确诊为AS伴葡萄膜炎的患者40例46眼,对其临床特征、实验室检查和诊治情况进行系统回顾性分析.结果:AS伴发葡萄膜炎患者40例46眼,其中男28例32眼,女12例14眼.平均发病年龄29.68±7.83岁,平均病程6.95±6.12a;葡萄膜炎病史3d~6a,平均病程28±15d.X线或CT检查显示均有骶髂关节炎.患者37例(93%)人白细胞抗原B27(human leukocyte antigen,HLA-B27)检查阳性,27例(68%)血沉(erythrocyte sedimentation rate,ESR)升高,18例(45%)C反应蛋白(C-reactive protein,CRP)升高.经过系统治疗后,患者的葡萄膜炎得到治愈或控制,实验室检查指标恢复正常.结论:AS伴发葡萄膜炎多累及中青年男性,多单眼发病,易复发;临床医生需警惕葡萄膜炎患者AS的发生.该类患者需及时、足疗程地系统治疗.     

A clinical evaluation of uveitis-associated secondary glaucoma

PURPOSE: To investigate the clinical features of secondary glaucoma associated with uveitis.METHODS: The subjects of the study were 1,099 patients with uveitis (1,604 eyes) treated at the Miyata Eye Hospital, Miyakonojo, Miyazaki, between October 1974 and January 2000. The intraocular pressure (IOP) and clinical data were analyzed retrospectively. Secondary glaucoma was diagnosed in the patients when IOP was higher than 21 mm Hg at two consecutive visits and they needed treatment with medication to control the high IOP.RESULTS: Secondary glaucoma was found in 293 eyes (18.3%) of 217 patients (19.7%) among the uveitis patients. The clinical entity with the highest incidence of secondary glaucoma was Posner-Schlossman syndrome in 100%, followed by sarcoidosis in 34.1%, herpetic anterior uveitis in 30.4%, Beh?et's disease in 20.8%, human leukocyte antigen-B27-related acute anterior uveitis in 20.0%, Vogt-Koyanagi-Harada's disease in 16.4%, and human T-lymphotropic virus type 1 uveitis in 16.2%. Among these 293 eyes with secondary glaucoma, the majority (72%) had active anterior uveitis at the time of high IOP. Only 7.5% of the secondary glaucoma eyes had peripheral anterior synechia wider than 180 degrees of the trabecular meshwork. Steroid-induced glaucoma was found in only 8.9% of the secondary glaucoma eyes. Surgical therapy, mainly trabeculectomy with anti-metabolites, was performed in 38 eyes and the post-surgical IOP was controlled under 20 mm Hg in 34 eyes. Despite the medical and surgical therapy for secondary glaucoma, visual field defect was found in 39% of the secondary glaucoma eyes.CONCLUSIONS: The incidence of secondary glaucoma in the 1,604 eyes with uveitis was 18.3%, but it differed depending upon the clinical entity of the uveitis. The evaluation and the management of IOP are very important in the treatment of patients with uveitis, in addition to the management of intraocular inflammation.     

650例前葡萄膜炎临床分析

目的探讨前葡萄膜炎的病因、类型、临床特点及预后。方法回顾性病例研究。分析2006年12月至2012年7月就诊于我院葡萄膜炎专科的650例前葡萄膜炎患者（856眼）的临床资料,根据病史、临床表现、合并全身性疾病、辅助检查及实验室检查等,对前葡萄膜炎的病因、临床特点、治疗效果及预后进行探讨。结果650例前葡萄膜炎患者（856眼）中单眼发病444例,双眼发病206例,男394例,女256例,男女比例为1．5：1;平均发病年龄（39．0±15．0）岁,20～50岁之间的青壮年患者占总病例的71．4％。急性期689眼,慢性期167眼。按病因主要分为特发性前葡萄膜炎（243例,37．4％）,不伴发全身关节病变的HLA—B27相关性前葡萄膜炎（123例,18．9％）,强直性脊柱炎（105例,16．2％）,Fuchs综合征（74例,11.4％）和病毒感染（44例,6．8％）。各种并发症发生率为39．5％,主要为并发性白内障（41．1％）和继发性青光眼（35．1％）。治疗后视力≥0．5者占75．4％,0．05～者占20．3％,〈0．05者占4-3％。结论前葡萄膜炎发病率高．病因复杂多样。易复发,如治疗不当将产生严重并发症。因此应对前葡萄膜炎患者进行详细、系统的检查,积极查因,从而指导临床治疗及预后。     

内因性葡萄膜炎354例临床分析

目的 探讨内因性葡萄膜炎的临床分布特点。方法 ６ａ间连续收集各类急性或复发性葡萄膜炎病人３５４例,行详尽的临床检查和血清免疫学检查。结果 在３５４例葡萄膜炎病人中,前葡萄膜炎１６５例（４６．６％）,后葡萄膜炎１１８例（３３．３％）,全葡萄膜炎５７例（１６．１％）,周边部葡萄膜炎１４例（４．０％）。致盲率为５．９％,致盲原因是增殖性视网膜病变、继发性青光眼和并发性白内障等,与全身病有关联者１６７例（４７．２％）,主要为骨关节后,才厅对葡萄膜炎进行病因学确诊和给予适当的治疗。     

Clinical and Demographic Characteristics of Patients with Uveitis Starting Later in Life

Abstract

Purpose: To evaluate uveitis cases presenting at older ages for the first time.

Methods: We retrospectively analyzed the clinical data related to the 90 eyes of 68 patients who presented with a first episode of uveitis at the age of ≥60 years and were seen at the Uveitis Division of the Ulucanlar Eye Hospital from 1996 to 2013.

Results: The location of the uveitis was anterior in 51 (75%) patients. Nine patients (13.2%) presented with panuveitis, 5 (7.3%) with posterior uveitis, and 3 (4.4%) patients with intermediate uveitis. Idiopathic uveitis in 23 (33.8%) and presumed herpetic anterior uveitis in 23 (33.8%) patients were the most common diagnoses, while other diagnostic entities accounted for 22 (32.3%) patients. The most common complications were elevation of intraocular pressure in 17.7%, cystoid macular edema (CME) in 11.1%, and corneal scar in 11.1% of eyes.

Conclusions: While idiopathic uveitis and presumed herpetic anterior uveitis were the most common causes, although in an endemic country, Behçet disease was not a common cause of uveitis in the elderly population.     

Anterior and intermediate uveitis cases referred to a tertiary centre in Alberta

BACKGROUND: We investigated the characteristics and causes of various uveitis subtypes in patients presenting to the Regional Eye Centre at the Royal Alexandra Hospital, University of Alberta, Edmonton, Alta., and estimated the incidence of anterior uveitis in northern Alberta. METHODS: A retrospective study was conducted of all patients presenting with uveitis to a single, full-time ophthalmologist at the Regional Eye Centre from September 2004 to June 2005. Uveitis was classified according to onset, severity, anatomical subtype, etiology, recurrence rate, and response to treatment. Statistical analysis was used to compare patients referred by ophthalmologists with those referred by non-ophthalmologists. RESULTS: Two hundred and nine eyes of 171 patients were included in the study. Ophthalmologist referrals consisted of 67.4% anterior, 14.0% intermediate, and 18.6% panuveitis, and non-ophthalmological referrals were 92.8% anterior, 5.4% intermediate, and 1.8% panuveitis. Referrals from ophthalmologists were significantly more likely to be chronic, recurrent, and (or) less responsive to treatment than referrals from other sources. INTERPRETATION: Referral bias strongly affects the proportions of uveitis subtypes seen. Human leukocyte antigen-B27-associated diseases (especially ankylosing spondylitis), sarcoidosis, and herpes infections should be considered among the most likely causes of uveitis to be diagnosed in this patient population.     

Clinical features and prognosis of herpetic anterior uveitis: a retrospective study of 111 cases

To describe the clinical features and outcomes in patients with herpetic anterior uveitis. We reviewed the records of 111 patients with a clinical diagnosis of herpetic anterior uveitis seen at the Department of Ophthalmology, Istanbul Faculty of Medicine, from January 1996 to December 2006. Demographic and clinical features, recurrence rate, and visual outcome were analyzed. Fifty patients were male, 61 were female. Mean age at presentation was 39.2 ± 16.5 (6–74) years. Three atopic patients had bilateral involvement. Twelve patients had active or a past episode of herpes zoster ophthalmicus. Ocular findings were granulamatous anterior uveitis (93%), active keratitis or corneal scars (57%), elevated intraocular pressure (51%), iris atrophy (48%), distorted pupil (25%), and posterior synechiae (26%). Secondary glaucoma developed in two patients. None of the patients had posterior segment complications. The recurrence rate was 0.45/person-year. Topical corticosteroids and oral antiviral therapy were administered to all patients during active episodes. Long-term prophylactic oral acyclovir was used in 13%. Final visual acuity was worse than 0.5 in 17% of the involved eyes and was due to corneal scarring or cataract formation. Patients with iridocyclitis only had no permanent visual loss. Herpetic anterior uveitis is a recurrent granulomatous disease commonly associated with corneal involvement, iris atrophy, and transient intraocular pressure rise. Visual prognosis is good, especially in patients who have only anterior uveitis without corneal disease.     

Global variation and pattern changes in epidemiology of uveitis

Uveitis, a complex intraocular inflammatory disease results from several etiological entities. Causes of uveitis are known to vary in different populations depending upon the ecological, racial and socioeconomic variations of the population studied. Tropical countries are unique in their climate, prevailing pathogens and in the existing diseases, which further influence the epidemiological and geographical distribution of specific entities. We provide an overview of the pattern of uveitis of 15221 cases in 24 case series reported from several countries over 35 years (1972-2007) and we integrate it with our experience of an additional 8759 cases seen over six years (1996-2001) at a large community-based eye hospital. Uveitis accounted for 0.8% of our hospital-based outpatient visits. The uveitis was idiopathic in 44.6%, the most commonly identified entities in the cohort included leptospiral uveitis (9.7%), tuberculous uveitis (5.6%) and herpetic uveitis (4.9%). The most common uveitis in children below 16 years (616 patients; 7.0% of the total cohort) was pediatric parasitic anterior uveitis, (182 children, 29.5% of the pediatric cohort), whereas the most common uveitis in patients above 60 years (642 patients; 7.3% of the total cohort) was herpetic anterior uveitis, (78 patients, 12.1% of the elderly cohort). Etiologies varied with the age group of the patients. As in other tropical countries, a high prevalence of infectious uveitis was seen in this population.     

The Etiology of Intraocular Inflammation in HIV Positive and HIV Negative Adults at a Tertiary Hospital in Cape Town,South Africa

Purpose: To describe the patterns of uveitis in South Africa.

Methods: Prospective cross-sectional study.

Results: One hundred and six patients were enrolled and 37.7% had human immune-deficiency virus (HIV) infection. Anterior and panuveitis occurred most frequently. Infectious, non-infectious and idiopathic uveitis were diagnosed in 66.0%, 17.0% and 17.0% of all cases, respectively. Eighty percent of HIV+ cases had infectious uveitis. Overall, intraocular tuberculosis (IOTB), herpetic and syphilitic uveitis were the commonest infectious causes. Sarcoidosis and HLA-B27-associated uveitis were the commonest non-infectious causes. In anterior uveitis, HIV+ cases most frequently had probable IOTB, syphilitic or idiopathic uveitis while HIV- cases had possible IOTB, idiopathic or HLA-B27-associated uveitis. In panuveitis, HIV+ cases mostly had syphilis, probable IOTB, toxoplasma and varicella-zoster virus whereas HIV- cases mostly had possible IOTB, sarcoidosis and idiopathic uveitis.

Conclusion: Infectious uveitis is common in South Africa, especially amongst HIV+ patients. Causes of anterior and panuveitis differ between HIV+ and HIV- patients.