更昔洛韦玻璃体腔注药术治疗急性视网膜坏死

目的 探讨更昔洛韦玻璃体腔注药术治疗急性视网膜坏死（ARN）的手术适应证、手术时机及其疗效。方法ARN住院患者14例（14只眼）,均符合美国葡萄膜炎学会ARN诊断标准。患者初诊视力为光感、眼前手动、数指者各1只眼,0．08～0．1者4只眼,0．2～0．4者5只眼,0．5、0．8者各1只眼。角膜后沉着物、房水闪光均阳性。眼底表现为周边部局灶性和（或）片状视网膜坏死、视网膜动脉白线、视网膜出血等。全身分别给予阿昔洛韦或更昔洛韦静脉滴注,患者病情继续发展、恶化,但尚未出现视网膜脱离。再对14只眼行更昔洛韦玻璃体腔注药术。其中2只眼注药后,病情不能控制,出现了增生性玻璃体视网膜病变（PVR）和视网膜脱离,即行玻璃体切除术。术后患者随访4～74个月,平均25个月。结果更昔洛韦玻璃体腔注药术后,12只眼视力显著提高,提高至1．0～1．5者5只眼,0．5～0．9者5只眼,0．3者2只眼。玻璃体切除术后的2只眼,术后视力较术前亦有提高,分别由眼前数指提高至0．4,光感提高至眼前数指。14只眼的眼前节炎性反应和玻璃体混浊消失或明显减轻,视网膜黄白色病变消退,出血吸收,视网膜在位。结论对全身抗病毒药物治疗不能控制病情的ARN患者,在尚未发生PVR或视网膜脱离时,及早给予更昔洛韦玻璃体腔注药术可获得满意疗效,能显著提高患者视力。（中华跟科杂志,2007,43：631-637）

Intravitreal injection of Ganciclovir in the treatment of acute retinal necrosis

OBJECTIVE: To evaluate the indication and clinical effects of intravitreal injection of Ganciclovir in the treatment of acute retinal necrosis (ARN). METHODS: Fourteen cases (14 eyes) of ARN which were consistent with the diagnostic criteria of American Uveitis Society were enrolled. Preoperative visual acuity was: light perception, hand movement and counting fingers (CF), each in 1 eye; 0.08 - 0.1 in 4 eyes; 0.2 - 0.4 in 5 eyes 0.5 in 1 eye and 0.8 in 1 eye. Keratic precipitate and aqueous flare were presented in the anterior segment. Peripheral focal and/or patch retinal necrosis, retinal occlusive arteritis and retinal hemorrhage were observed in the fundus. Acyclovir or Ganciclovir was administrated sysmatically by intravenous injection. The condition of 14 eyes deteriorated underwent intravitreal injection of Ganciclovir but without retinal detachment. After intravitreal injection 2 eyes became worse and underwent vitrectomy for PVR and retinal detachment. The follow-up time varied from 4 to 74 months (mean 25 months). RESULTS: The inflammation of anterior segment and vitreoretinopathy of 14 cases disappeared after intravitreal injection of Ganciclovi. The visual acuity markedly increased in 12 eyes without surgical intervention. Visual acuity achieved 1.0 - 1.5 in 5 eyes, 0.5 - 0.9 in 5 eyes and 0.3 in 2 eyes after intravitreal injection of Ganciclov. The retina of the 2 eyes undergone vitrectomy was reattached and their visual acuity improved from CF to 0.4 and LP to CF, respectively. CONCLUSIONS: In ARN patients whose conditions could not be controlled by systemic antivirus medicine treatment, early intravitreal injection of Ganciclovir can yield satisfactory therapeutic effects and better visual prognoses if applied before the occurrence of PVR or retinal detachment.