急性视网膜坏死综合征的临床分析

目的 观察急性视网膜坏死综合征(ARN)的临床特征.方法 回顾性分析84例98只眼ARN患者的临床资料.患者进行了最佳矫正视力、眼压、B型超声检查、裂隙灯生物显微镜、前置镜、直接和(或)间接检眼镜结合三面镜检查,屈光间质清楚者行荧光素眼底血管造影.部分患者行聚合酶链反应(PCR)检查鉴定致病病毒种类,明确诊断ARN后抗病毒、选择性激光和玻璃体手术治疗.并对视力和眼底情况进行随访,平均随访时间24.1个月.结果 ANR患者平均发病年龄42.8岁,双眼发病率16.6%,视网膜脱离发生率57.1%.治疗后6个月和12个月以上视力高于0.02者分别为53.5%和35.5%.确诊时间在14 d内的ARN患眼以及双眼发病的继发眼预后较好.水痘-带状疱疹病毒是本组ARN的主要致病病毒,占62.5%;单纯疱疹病毒-1型ARN与脑炎等中枢神经系统疾病密切相关.结论 ARN急性起病,视网膜脱离发生率高,后期易出现严重视网膜血管病变,预后差.发病早期临床误诊多见,必要时可做PCR检查帮助明确诊断.     

Vogt-小柳-原田综合征漏误诊分析

目的：分析我国Vogt-小柳原田（VKH）综合征临床诊断中存在的问题。方法：对1996年1月－2000年12月于中山眼科中心葡萄膜炎专科就诊的,以往资料完整的123例VKH综合征患者的临床资料。特别是漏诊,误诊,发病至确诊时间和以往诊断等进行分析。结果：123例VKH综合征患者的盲目发生率为28．9％,在后葡萄膜炎期,前葡萄膜受累期和以前葡萄膜炎反复发作为特征的全葡萄膜炎期的漏诊,误诊率分别为96．7％,86．2％和74．0％,眼部发病至确诊时间平均为24．5个月。结论：我国VKH综合征患者的漏诊和误诊十分常见,诊断水平亟待提高。     

急性视网膜坏死综合征的诊断与治疗

复习急性视网膜坏死 (ARN)综合征有关的文献 ,分析其发病原因、临床特征、诊断技术和治疗方法。大多数ARN综合征的病因是HSV Ⅰ、HSV Ⅱ或VZV感染所致 ,少数是CMV感染。PCR技术方便和灵敏度高 ,抗体免疫测定技术准确度高 ,但ARN综合征的诊断以临床特征为主要参考依据。全身应用抗病毒药物是经典的用药途径 ,必要时可以玻璃体内注射。玻璃体视网膜手术有利于严重病例视功能的保存和提高。ARN综合征的预后较差 ,及时准确的诊断及早期治疗 ,可以改善预后     

急性视网膜坏死患者接受抗病毒治疗后眼底坏死面积与房水病毒载量的动态变化分析

目的 分析急性视网膜坏死(ARN)患者接受抗病毒治疗后,房水中的水痘-带状疱疹病毒(VZV载量与眼底坏死面积的动态变化规律。方法 15例患者确诊ARN后接受联合抗病毒治疗,在确诊当天和随后大约1周、2周、3周和4周评估活动性视网膜坏死病灶的范围,在玻璃体腔注药之前进行前房穿刺取房水样本,采用实时定量聚合酶链反应法检测房水中VZV载量。利用超广角眼底成像系统评估和计算眼底坏死面积。结果 15例患者房水中VZV-DNA平均初始载量为(7.08±0.86)lg(copies/mL)。初诊时有影像记录资料的9例患者平均坏死面积为27.5%±25.2%。接受治疗后,15例患者患眼房水中病毒载量和眼底坏死面积均呈下降趋势。初始病毒载量半衰期的预期时间为(3.2±0.7)d,眼底坏死面积半衰期的预期时间为(6.8±4.7)d。结论观察病毒载量及眼底坏死面积变化有助于监测ARN患者的治疗效果。     

急性视网膜坏死综合征的诊断与治疗

复习急性视网膜坏死（ARN）综合征有关的献，分析其发病原因，临床特征，诊断技术和治疗方法。大多数ARN综合征的病因是HSV-Ⅰ，HSV-Ⅱ或VZV感染所致，少数是CMV感染，PCR技术方便和灵敏度高，抗体免疫测定技术准确度高，但ARN综合征的诊断以临床特征为主要参考依据。全身应用抗病毒药物是经典的用药途径，必要时可以玻璃体内注射，玻璃体视网膜手术有利于严重病例视功能的保存和提高，ARN综合征的预后较差，及时准确的诊断及早期治疗，可以改善预后。     

急性视网膜坏死综合征的临床观察

目的:探讨急性视网膜坏死综合征(acute retinal necrosis ARN)临床诊断、治疗的有效方法.方法:回顾性分析我院2003-09/2006-07以来8例11眼ARN患者的临床表现、检查、诊治及预后.结果:8例患者中除1例1眼无眼前段表现外,其余7例(10眼)都表现为不同程度的眼前段炎症、玻璃体炎、坏死性视网膜炎和闭塞性视网膜血管炎.8例中1例(1眼)HSV-1阳性.治疗后视力提高共5眼(46%),最终视力≤0.1者7眼(64%).随访期内10眼(91%)病变控制.结论:ARN的诊断以临床表现为主.早期足量地抗病毒并联合应用糖皮质激素、预防性视网膜光凝、必要时玻璃体手术是控制病变的关键.     

治疗急性视网膜坏死综合征的临床体会

目的 探讨急性视网膜坏死(ARN)的发病特点及其治疗。方法 对我院2000年7月～2003年3月收治的8例11眼患者进行回顾性总结，就其临床表现、诊断和治疗进行分析。结果 经大剂量抗病毒药物及皮质类固醇激素治愈4眼；经巩膜扣带术联合玻璃体切割及眼内硅油填充术治愈6眼，治疗效果满意，均无复发，仅1例患者放弃治疗，最终失明。结论 眼科医生要充分认识ARN发病的临床特点，仔细进行眼底检查，以免误诊漏诊。一旦确诊ARN，应及时正确的应用各种治疗手段以保存或挽救患者的有用视力。     

急性视网膜坏死临床分析

急性视网膜坏死综合征（acute retinal necrosis,ARN）是由疱疹病毒引起的以急性前葡萄膜炎、玻璃体炎、闭塞性视网膜血管炎、视网膜坏死、视网膜脱离为主要特征的眼部综合征,误诊率较高,现在将2003年1月至2009年3月我院诊治的9例（12只眼）ARN报告如下。     

Vogt-小柳-原田综合征的临床误诊分析

目的:通过分析Vogt-小柳-原田综合征(Vogt-koyanagi-harada syndrome,VKH)的确诊过程,找出临床诊断中存在的问题。方法:对2005-01/2010-12于我院眼科就诊的、以往资料完整的15例VKH综合征患者的临床资料,通过回顾性资料分析,查找误诊、漏诊的原因。结果:VKH综合征患者15例的误诊率高达80%。最常误诊为结膜炎、视盘血管炎、黄斑病变、后巩膜炎、青睫综合征、中心性浆液性视网膜炎、角膜炎或笼统诊断为葡萄膜炎。本组15例患者中有5例10眼因未及时准确的治疗导致患者视力低于0.3。结论:误诊的原因主要与没有详细询问病史、对VKH综合征的临床特征及全身表现缺乏认识。可见,VKH综合征的诊断水平亟待提高。     

急性视网膜坏死治疗的临床观察

急性视网膜坏死(ARN)是以视网膜血管炎、玻璃体和眼前节炎症、视网膜坏死以及后期出现视网膜脱离为特征的严重致盲眼病[1].因其发病急骤,进展迅速,若不能及时确诊并进行有效地治疗,预后极差.现将我院收治的ARN患者14例20只眼的临床资料回顾报告如下.     

Herpes simplex virus type 2 as a cause of acute retinal necrosis syndrome in young patients

PURPOSE: To determine the causative virus in acute retinal necrosis (ARN) syndrome in a series of patients by calculation of modified Witmer coefficients. DESIGN: Noncomparative case series. PARTICIPANTS: Ten patients with ARN syndrome from four medical centers. METHODS: Aqueous samples, vitreous samples, or both were collected prospectively during surgery from patients with a clinical diagnosis of ARN syndrome. Serologic measures of intraocular and serum antibodies to potentially causative viruses were measured by enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Modified Witmer coefficients (immunoglobulin G and immunoglobulin A) for herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV), and cytomegalovirus (CMV), as well as adenovirus type 2, were calculated from aqueous or vitreous samples, or both. RESULTS: Intraocular antibody measurements were strongly suggestive of a single diagnosis in 9 of 10 patients tested. Modified Witmer coefficients demonstrated intraocular antibody production to HSV in five patients and antibodies to VZV in four patients, and the measurement was inconclusive in one patient. No patients were positive for adenovirus or CMV. Strain-specific antibody titers demonstrated that all HSV-positive patients were reactive only to HSV-2. Herpes simplex virus type 2 was found predominantly in younger patients with ARN syndrome (mean age, 21.2 +/- 10 years; range, 17-39 years), whereas VZV was more commonly seen in older patients (mean age, 40.8 +/- 12.2 years; range, 29-58 years; P = 0.033). Immunoglobulin A testing confirmed immunoglobulin G testing in all patients examined. CONCLUSIONS: Although VZV is thought to be the most common cause of ARN syndrome, HSV-2 is an important cause of ARN syndrome, particularly in younger patients. Because infection with HSV-2 has important medical ramifications, these results suggest that determination of a causal agent should be considered in some cases of ARN syndrome.     

Photocoagulation to prevent retinal detachment in acute retinal necrosis

Retinal detachment (RD) occurs in more than 50% of eyes with acute retinal necrosis (ARN) and is the leading cause of visual loss in this syndrome. In order to decrease the incidence of RD in ARN, the authors treated 12 eyes of 10 patients with prophylactic laser photocoagulation. Retinal detachment occurred in two eyes (17%). Over the same time period, seven eyes with ARN did not receive prophylactic laser treatment, most often because of dense vitreous debris, with a 67% rate of RD. Prophylactic photocoagulation treatment should be considered in the management of patients with ARN.     

首诊于眼科小儿抽动障碍的临床特征分析

目的 总结首诊于眼科的抽动障碍(TD)的临床特征及其被误诊或漏诊的原因.方法 分析2009年2～11月以"眨眼"为主诉首诊于眼科618例患者中诊断为TD患者的临床资料.结果 (1)最终诊断为TD者187例,占"眨眼"为主诉患儿的30.3%,男女均列为4.2:1,其中短暂性抽动(TTD)102例(54.5%),慢性抽动(CTD)62例(33.2%),多发性抽动(TS)23例(12.3%).(2)主诉为单纯眨眼123例(65.8%),伴眼部其他不适64例(34.2%);78例(41.7%)眼部无阳性体征,67例(35.8%)有结膜充血、滤泡或乳头,42例(22.5%)伴有眼部其他体征;全部以运动抽动首发,37例伴发声抽动;抽动部位主要位于头面部(73.7%),抽动形式主要为简单抽动(91.7%);合并有精神损害47例(25.1%),其中35例为ADHD.(3)误诊情况:243例有外院就诊史的"眨眼"患者最终被诊断为TD81例,其中58例漏诊或误诊(23.9%).结论 (1)抽动障碍是异常眨眼的主要原因之一.(2)首诊于眼科的TD多为TTD,抽动部位多位于头面部,以运动抽动为主,抽动形式主要为简单抽动;合并精神行为损害较少.(3)首诊于眼科的TD可合并眼部器质性病变同时存在;(4)误诊的原因主要是眼科医生认识混乱以及病情较轻,易被忽视所致;而与眼部器质性病变同时存在则是漏诊的主要原因.     

Acute retinal necrosis: an unusual presentation.

Acute retinal necrosis (ARN) is a visually devastating disease consisting of necrotizing retinitis in healthy patients. The retinitis usually begins in the midperiphery to periphery and may spread to the posterior pole. Milder cases of ARN involving the posterior pole have been described. However, these cases never progress to full-blown ARN and have relatively good visual outcomes. A case is reported of a young, white woman with ARN that originally presented in the posterior pole. Unlike mild cases, spread to the midperiphery and periphery ensued until full-blown ARN occurred. This disease may present not only as an acute mid-peripheral to peripheral retinitis, but it also must be considered in the differential diagnosis of patients with multifocal, punctate areas of retinitis in the posterior pole.     

Overview and Diagnosis of Acute Retinal Necrosis Syndrome

Acute retinal necrosis (ARN) syndrome, also known as Kirisawa's uveitis, is one of the most serious ocular diseases, and is characterized by a combination of peripheral, confluent, necrotizing retinitis, retinal arteritis, and intraocular inflammation. ARN syndrome is caused by the herpesvirus family, including herpes simplex virus (HSV) and varicella-zoster virus (VZV). The diagnosis of ARN syndrome is fundamentally based on clinical appearance and the demonstration of viral infection. Recently, polymerase chain reaction techniques permit detection of very small amounts of viral DNA in intraocular specimens. This knowledge can help in both the diagnosis and design of therapeutic strategy for ARN syndrome. Here we review the clinical presentation and the current advances in the diagnosis of ARN syndrome.     

Overview and diagnosis of acute retinal necrosis syndrome

Acute retinal necrosis (ARN) syndrome, also known as Kirisawa's uveitis, is one of the most serious ocular diseases, and is characterized by a combination of peripheral, confluent, necrotizing retinitis, retinal arteritis, and intraocular inflammation. ARN syndrome is caused by the herpesvirus family, including herpes simplex virus (HSV) and varicella-zoster virus (VZV). The diagnosis of ARN syndrome is fundamentally based on clinical appearance and the demonstration of viral infection. Recently, polymerase chain reaction techniques permit detection of very small amounts of viral DNA in intraocular specimens. This knowledge can help in both the diagnosis and design of therapeutic strategy for ARN syndrome. Here we review the clinical presentation and the current advances in the diagnosis of ARN syndrome.     

Presumed varicella zoster retinitis in immunocompromised patients

The acute retinal necrosis (ARN) syndrome is a morphologically defined necrotizing retinitis, occurring in apparently otherwise healthy patients. It has been shown that the varicella zoster virus is at least one cause of the ARN syndrome; treatment with acyclovir has proven to be effective for the infectious component of ARN. We report three immunocompromised patients who developed cutaneous herpes zoster and a necrotizing retinitis that was morphologically similar to the ARN syndrome. All three patients responded promptly to treatment with acyclovir, an agent highly effective against varicella zoster and herpes simplex viruses, but ineffective in the treatment of cytomegalovirus. While cytomegalovirus retinitis is more common in immunocompromised patients, these patients may occasionally develop an ARN-like retinitis, presumably as a result of the varicella zoster virus, which responds to treatment with acyclovir.     

Chickenpox-associated acute retinal necrosis syndrome.

Acute retinal necrosis (ARN) syndrome usually occurs as the result of secondary reactivation of latent, previously acquired, varicella-zoster or herpes simplex virus. The authors report four patients who developed a mild form of ARN within 1 month (5 to 28 days) after the onset of chickenpox. In contrast to typical cases of ARN, these cases were less severe, with retinitis limited to two quadrants or less (three patients), no retinal detachment (four patients), minimal vitreitis (four patients), and no loss of visual acuity (four patients). Thus, ARN may occur during the course of primary varicella-zoster infection.     

超声在硅油眼检查中的误诊率

目的 探讨眼科超声在硅油眼检查中诊断视网膜脱离的误诊率.方法 对208例215只眼玻璃体视网膜疾病患者行玻璃体切割及硅油填充术,在硅油填充术前、硅油填充期、硅油取出术后分别进行B超检查.结果 术前超声诊断符合率为100%,硅油填充期超声诊断的准确率为98.60%.误诊率为1.40%.取油后超声诊断的准确率为96.28%,误诊率为3.72%.结论 超声诊断对视网膜疾病的准确率较高,但是也无法完全避免误诊、漏诊情况,尤其是硅油填充时,为避免误诊和漏诊,超声检查时,不但要注意按操作时反复多轴向多切面扫描,仔细观察强回声带运动情况,判断光带与球壁、晶状体、玻璃体的关系,还要密切结合临床其他有关资料,进行综合分析.