Fuchs异色性虹膜睫状体炎临床特征及并发症处理

目的 分析Fuchs异色性虹膜睫状体炎患者的临床特征并探讨其并发症的临床治疗.方法 回顾性系列病例研究.选取1994年4月至2010年11月于青岛眼科医院就诊并且诊断为Fuchs异色性虹膜睫状体炎的患者101例(104眼),排除存在高血压、糖尿病、激素用药史、外伤等能引起眼部病变因素者,按年龄分为20～30岁、31～40岁、41～50岁、51～60岁、61～70岁、71～78岁6个年龄段,收集包括发病年龄、性别、病程、临床表现、并发症、手术方式、术后3d及长期随访的眼压及视力等临床资料.采用SPSS 17.0软件对术前与术后3d眼压、最佳矫正视力行配对符号秩和检验；对正常人与患病者角膜内皮细胞、六边形细胞比例、细胞变异率行独立样本秩和检验.结果 101例患者中3例(3.0％)双眼发病,男女之比1.2:1,各年龄段男女患病差异无统计学意义(x2=9.31,P＞0.05),左右眼患病差异无统计学意义(x2=10.628,P＞0.05).临床表现:100％患者视力下降;25.0％有角膜内皮色素沉着物,75.0％为脂状沉着物；24.0％患者发生虹膜异色；56.7％虹膜萎缩；100％患者玻璃体混浊；98.1％患者并发白内障;仅16.3％患者并发青光眼.与正常人相比,其角膜内皮细胞数目无明显减少,差异无统计学意义(Z=-1.601,P＞0.05)；六边形细胞比例无明显降低,差异无统计学意义(Z=-0.961,P＞0.05),细胞变异率无明显升高,差异无统计学意义(Z=-0.321,P＞0.05).并发白内障者行白内障超声乳化联合人工晶状体植入术,术后3d视力较术前明显提高,差异有统计学意义(Z=-2.201,P＜0.05);并发青光眼者行小梁切除术,术前与术后3d眼压差异有统计学意义(Z=-2.201,P＜0.05)；长期随访,有3例患者白内障术后1年并发青光眼,行小梁切除术后眼压稳定,视力无明显下降.结论 Fuchs异色性虹膜睫状体炎临床特征以视力下降、角膜内皮色素沉着物或脂状沉着物沉着、虹膜不同程度脱色素萎缩,甚至出现虹膜异色、前房及玻璃体轻度炎症表现为特点,随着病程的延长虹膜异色发生率可能增加;其对角膜内皮细胞数目、六边形细胞比例及细胞变异率无明显影响;抗青光眼手术或白内障术后患者的眼压仍需定期随访,以及时控制眼压保存视力.

Fuchs' heterochromic iridocyclitis: analysis of clinical characteristics and treatment of complications

Objective To analyze the clinical characteristics of Fuchs＇ heterochromic iridocyclitis and discuss clinical therapy methods. Methods It was a retrospective case-series study. Patients with histories of hypertension, diabetes, injury, or steroid use were excluded since these conditions can cause other diseases of the eye. One hundred and four eyes of 101 patients who were diagnosed with Fuchs＇ heterochromic iridocyclitis between April 1994 and November 2010 were included in the study. The patients were divided into six groups according to their age： 20-30 years old, 31-40 years old, 41-50 years old, 51-60 years old, 61-70 years old, 71-78 years old. Statistical data included age, gender, course of disease, clinical presentations, complications, and follow-up visual acuity and intraocular pressure examinations after surgery. SPSS 17.0 was used to analyze preoperative intraocular pressure and visual acuity comparing with postoperative by Wilcoxon matched pairs signed-ranks test, corneal endothelial cell number, sexangular cell ratio and coefficient of variation comparing with normal by independent samples rank test. Results Three of 101 patientswere bilateral （3.0%）; there was no difference in occun＇ence sides （Z2=10.628, P〉0.05）. The ratio of males versus females was 1.2：1, and was not statistically significant （Z2=9.51, P〉0.05）. The percentage of patients who presented with different clinical manifestations were as tbllows： reduced visual acuity （100.0%）, pigmented keratic precipitates （25.0%）, mutton fat keratic precipitates （75.0%）, iris atrophy （56.7%）, heterochromia （24.0%）, vitreous opacification （100.0%）, cataract （98.1%） and glaucoma （16.3%）. Corneal endothelial cell number （Z=-l.601, P〉0.05）, sexangular cell ratio （Z=-0.961, P〉0.05） and coefficient of variation （Z=-0.321, P〉0.05） were insignificant compare with normal. Visual acuity improved significantly after cataract extraction with intraocular lens implantation （Z=-2.201, P〈0.05）, anti-glaucoma surgery was performed to maintain normal intraocular pressure （Z=-2.201, P〈0.05）. Secondary glaucoma occurred in 3 of 6 patients after cataract extraction surgery during the regular one-year follow-up period; 4 patients who underwent anti-glaucoma surgery had normal intraocular pressure during the regular foflow-up period. Conclusion Fuchs＇ heterochromic iridocyclitis is characterized by reduced visual acuity, pigmented or mutton fat keratic precipitates, Ms atrophy and depigmentation, even heterochromia, mild inflammation of the anterior chamber and vitreous, and an increased incidence of heterochromia over an extended period. Corneal endothelial cells, sexangular cell ratio and the coefficient of variation were normal. Patients underwent cataract extraction and anti-glaucoma surgery need regular follow-up to maintain intraocular pressure and vision.