人工晶状体植入术后迟发性葡萄膜炎的治疗观察

目的探讨人工晶状体植入术后迟发性葡萄膜炎的治疗及病因。方法回顾性分析38例(43眼)人工晶状体植入术后迟发性葡萄膜炎的发病原因,进行了散瞳、结膜下及球周注射地塞米松、妥布霉素、玻璃酸酶等综合治疗。结果自身免疫反应和术后擅自停药、劳累为发病主要原因。本组患者经3～7 d治疗,视力恢复良好。结论本病可能是免疫复合物介导的急性葡萄膜炎症,及时正确处理可获得较好的视力。早期避免局部停药、劳累可降低其发生率。     

中医药治疗内因性前葡萄膜炎的随机对照临床试验质量评价

目的对有关用中医药治疗内因性前葡萄膜炎文献进行系统性评价,了解研究质量的总体水平及中医药和中西医结合治疗内因性前葡萄膜炎的有效性。方法检索Medline(1966~2005年)、Em-Base(1974~2005年)、Cochrane Library光盘2005年第1期的Cochrane Controlled Trials Register、Current Con-trolled Trials和The National Research Register数据库;同时检索中国医学文献数据库(光盘)CBMdisc,中文生物医学期刊数据库(光盘版)CMCC,VIP中文科技期刊数据库(Web版),CNKI中国期刊全文数据库(Web版),万方数据库,中国医学学术会议论文数据库(CMAC)并辅以手工检索。结果共收集到有关中医药治疗内因性前葡萄膜炎的临床对照文献3篇,有1篇文献抽签随机,有2篇文献按就诊顺序半随机。3篇均未使用盲法。所有文献均无随机方案的隐藏。结论目前检索到国内外发表的有关内因性前葡萄膜炎中医药治疗性的文献大多以专家个人经验或专题组临床经验为主,缺少系统评价的依据。中医药治疗内因性前葡萄膜炎的疗效评价尚待根据高质量的大样本随机对照临床试验的结果进一步论证。     

葡萄膜炎并发性白内障瞳孔粘连的手术治疗

目的:探讨葡萄膜炎并发白内障虹膜后粘连小瞳孔状态下手术技巧、时机及疗效。方法:对45例56眼葡萄膜炎并发性白内障小瞳孔患者,在葡萄膜炎控制稳定,炎症消退3个月后,借助粘弹剂分离虹膜后粘连或施行瞳孔环型扩张,再行白内障超声乳化或囊外摘出及人工晶体植入。结果:术后48眼(85%)视力较术前提高,其中≥0.5者19眼,0.3～0.5者13眼,0.1～0.3者16眼。瞳孔圆形或椭圆形。术后眼压均控制在正常范围。结论:葡萄膜炎并发性白内障虹膜后粘连,可使瞳孔扩大成圆形或椭圆型,有利于实施白内障超声乳化或囊外摘除,且瞳孔括约肌不受损伤,避免术后眩光,可获得良好视力,术中、术后并发症减少。     

Vogt-Koyanagi-Harada disease associated with interferon alpha-2b/ribavirin combination therapy

Summary. The complex immunological effects of interferon and ribavirin therapy (IFN/R) in hepatitis C virus (HCV) may also exacerbate or trigger the de novo development of autoimmunity. We report the first case of IFN/R therapy associated with Vogt-Koyanagi-Harada disease, a T-cell-mediated autoimmune response to melanocytes. This condition, which has characteristic ocular, neurological and integumentary findings, elicits a systemic prodrome that may mimic side-effect profile and delay of IFN or mask its recognition. We discuss this disease in the context of the known immunomodulatory effects of IFN-alpha and ribavirin and suggest potential mechanistic explanations for the association.     

Ocular manifestation of primary nervous system lymphoma: what can be expected from imaging?

Primary ocular lymphoma, which affects the posterior parts of the eye, is an ocular manifestation of primary central nervous system lymphoma (PCNSL). It used to be the ocular disease with the shortest time of survival, even worse than ocular melanoma. Death ensues by CNS dissemination. Unfortunately, ocular lymphoma may be the initial manifestation of PCNSL and diagnosis is frequently difficult, even if vitreal biopsy is performed. Therefore, it should be determined whether cross sectional imaging may be helpful in detection and differential diagnosis of ocular lymphoma. MRI of seven patients (female = 6, male = 1, median age 62 years) with biopsy proven ocular lymphoma were retrieved from the files of our hospital and of a multicenter PCNSL study. In four patients, ocular lymphoma was the first manifestation of PCNSL, in three a cerebral lesion had occurred in the first place. Progression to cerebral lymphoma was seen in three of the four patients with initial eye manifestation. Imaging was performed using a dedicated thin section protocol in four patients. An intraocular abnormality was found in four cases, always in T1-weighted images after contrast injection. Differential diagnosis from uveitis or ocular melanoma was not possible by imaging alone. The examination was falsely negative in the remaining three patients. Hence, imaging has a low sensitivity for ocular lymphoma and does not facilitate differential diagnosis against uveitis or ocular melanoma. Received: 17 April 2002, Accepted: 9 July 2002 Correspondence to Dr. W. Küker     

人工晶状体植入术后的迟发性葡萄膜炎

目的探讨人工晶状体植入术后的迟发性葡萄膜炎的发病原因及预防方法。方法对不同类型的白内障囊外摘出联合人工晶状体植入术后所发生的迟发性葡萄膜炎11例(11眼)进行回顾性总结,分析其发病原因、发病时间、临床特点及预防方法。结果术后迟发性葡萄膜炎发生率为1.65%;自身免疫反应和术后抗生素、皮质类固醇用量不足是发病的主要原因;本病对皮质类固醇治疗敏感,只要及时治疗,一般预后良好。结论本病是由自身免疫变态反应引起的葡萄膜炎,术中尽量清理残余皮质,术后抗生素、皮质类固醇不可过早停药是降低本病的发生率的关键。     

雷公藤多甙对急性前葡萄膜炎患者血清IL-2及TNF-α水平的影响

目的：探讨雷公藤多甙（TWP）对急性前葡萄膜炎（AAU）患者血清白细胞介素－2（IL－2）及肿瘤坏死因子（TNF－α）水平含量的影响。方法：将患者随机分为两组，观察组50例，以TWP治疗为主；对照组50例，以乙双吗啉治疗为主，对两组患者治疗前后进行血清IL－2及TNF－α水平含量检测，并与50例健康者对照。结果：观察组治疗前IL－2及TNF－α水平含量分别为（1．31±0．27）μg/L及（1．20±0．65）μg/L，治疗后为（1．19±0．27）μg/L及（0．96±0．54）μg/L，与治疗前比较差异均有显著性（t=2.22及2．00，P＜0．05）；对照组治疗前分别为（1．31±0．26）μg/L及（1．22±0．66）μg/L，治疗后为（1．20±0．27）μg/L及（0．98±0．51）μg/L，与治疗前比较差异均有显著性（t=2.08及2．03，P＜0．05）。观察组及对照组IL－2、TNF－α治疗前均明显高于健康组（P均＜0．05），而治疗后均接近健康组（P均＞0．05）。结论：（1）AAU患者存在IL－2及TNF－α异常改变；（2）TWP对AAU患者IL－2及TNF－α有明显抑制作用；（3）TWP治疗AAU临床疗效可靠。     

Juvenile idiopathic arthritis profile in Turkish children

Background: Juvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders. Publications from different countries point to differences in the disease manifestation of JIA among different populations. The aim of the present paper was to evaluate the clinical and laboratory features of JIA in Turkish children. Methods: A total of 196 JIA patients who fulfilled International League of Associations for Rheumatology (ILAR) diagnostic criteria were included in this retrospective study. The data collected were age, gender, age at disease onset and at diagnosis, and follow‐up duration. Antinuclear antibody (ANA), rheumatoid factor (RF), and human leukocyte antigen B‐27 were evaluated for each patient. Results: There were 102 boys and 94 girls with a mean duration of disease of 4.1 years. The mean age at the first visit was 8.8 years, and the mean age at onset of disease was 6.8 years (range, 8 months–15 years). Polyarticular JIA was the most frequent onset type (37.2%). Other subtypes included oligoarthritis (34.2%), systemic arthritis (15.3%), psoriatic arthritis (1%), enthesitis‐related arthritis (9.7%), and other arthritis (2.2%). ANA was positive in 28 patients (14.2%). Chronic uveitis occurred in two patients with oligoarthritis; and two patients with enthesitis‐related arthritis had acute uveitis. Three patients (1.4%) developed amyloidosis. Conclusion: Compared to reports from Western countries, remarkably different features of JIA were found in Turkish children, which included higher frequency of polyarticular JIA, higher prevalence among boys, lower rate of ANA positivity and uveitis. Further studies are required to understand how genetic and environmental differences affect JIA expression.