Vogt-小柳-原田综合征的大量激素疗法

目的探讨Vogt-小柳-原田综合征的大量激素治疗的临床经过及荧光素眼底血管造影(fundus fluorescein angiography，FFA)、吲哚青绿(fundus indocyanine green agiography，ICGA)眼底血管造影在不同时期的改变情况。方法分析1992年1月至1995年12月间日本关西医科大学眼科教研室应用大量激素治疗Vogt-小柳-原田综合征新鲜病例31例62眼。运用大剂量强的松龙，方法为首剂每日100—200mg行静脉滴注，根据眼底改变及FFA、ICGA所见改变情况而行激素递减，激素最低用药期限为6个月。结果激素治疗开始后，FFA造影平均10d后开始改善，渗出性视网膜脱离及后极部视网膜水肿的消退时间平均为36d，ICGA造影平均78d开始改善。在激素递减过程中，由于眼底所见恶化而增加激素用量的病例有6例，而激素用药停止后未见复发病例。结论大量激素疗法治疗Vogt-小柳-原田综合征是行之有效的，治疗过程中如果对激素逐渐减量、间歇给药的话可以预防Vogt-小柳-原田综合征的复发，同时激素的减量应按照FFA和ICGA造影所见的共同改善情况而减量。

Massive systemic corticosteroid for Vogt-Koyanagi-Harada syndrome

Objective To study massive corticosteroid management on Vogt-Koyanagi-Harada syndrome and observe the findings of fundus fluorescein angiography (FFA) and fundus indocyanine green angiography (ICGA) findings in different stages.Methods Applied massive corticosteroid on 31 cases (62 eyes) of acute stage harada's syndrome in the Department of Ophthalmology, Japan Kansai Medical University from Jan, 1992 to Dec, 1995. An equivalent of 100 mg to 200 mg prednisolone per day was given as the initial dosis, to be tapered off according to the fundus, findings of FFA and ICGA. Treatment was continued for at least 6 months.Results FFA findings improved after an average of 10 days of treatment. And it took an average of 36 days to be resolution of retinal detachment or to be retinal edema in the posterior fundus. An average of 78 days is needed before the ICGA findings improved. Corticosteroid had to be increased in 6 cases due to recurrence during tapering. There was no recurrence in termination of corticosteroid treatment after initial cure.Conclusion The findings show the efficacy of massive corticosteroid on treating Vogt-Koyanagi-Harada syndrome. We may prevent the recurrence of Vogt-Koyanagi-Harada syndrome by decreasing dosis gradually and administering intermittently. And corticosteroid dosis must be decreased by the improvement of findings of both FFA and ICGA.