梅毒性后葡萄膜炎的临床特征及治疗

目的 探讨梅毒性后葡萄膜炎患者的临床特征及治疗预后.方法 回顾性系列病例研究.收集26例经临床及血清学检查确诊的梅毒性后葡萄膜炎患者临床资料,回顾性分析患者的临床特征及治疗预后.结果 26例(40只眼)患者中,有14例患者为双眼发病.其中男性16例,女性10例;年龄21～58岁,平均40岁.患者均以视力下降、眼前黑影飘动等为主诉.眼底检查可见22只眼的视乳头轻度充血,黄斑中心凹反射消失;8只眼的后极部有黄白色病灶;6只眼的视乳头充血肿胀;其余4只眼的眼底改变不明显.荧光素眼底血管造影(FFA)检查,显示40只眼的视乳头有荧光素着染或呈强荧光,26只眼的视网膜静脉有荧光素渗漏灶,6只眼的视网膜色素上皮有荧光素积存,6只眼出现黄斑囊样水肿.40只眼均行脉络膜吲哚氰绿血管造影检查,显示眼底后极部有鳞状或播散性的弱荧光改变.给予静脉滴注青霉素类药物,病情严重者辅以小剂量糖皮质激素短期口服治疗,32只眼视力提高,眼底病变消退.结论 梅毒性后葡萄膜炎患者具有典型的临床特征,是一种可以治愈的疾病,早期诊断和正规治疗对于患者的预后至关重要.

Clinical characteristics and treatment of syphilitic posterior uveitis

Objective To study clinical characteristics,treatment and prognosis of syphilitic posterior uveifis.Methods A retrospective stuay was conducted in 26 patients with syphilitic posterior uveitis.The diagnosis was confirmed by clinical and laboratory tests.Results There were 26 patients,16 males and 10 females,mean age was 40 years.Fourteen patients were bilateral.The symptoms included impaired vision and floaters.In 40 eyes,yellow-white lesions in the posterior pole were present in 8 eyes,22 eyes showed mild congestion of optic discs and loss of reflex in the fovea,and 6 eyes showed significant congestion and swelling of the optic disc.Fluorescein angiography showed staining or hyperfluorescence of optic disc in 40 eyes,venous leakage in 26 eyes,retinal pigment epithelium damage with dye pooling in 6 eyes,and cystoid maeular edema in 6 eyes.ICGA:squamous or disseminative hypofluorescence damage web present in all 40 eyes.After the treatment,32 eyes had improved vision and fundus damage.Conclusions Syphilitic posterior uveitis has typical symptoms and signs.This is a curable disease,early diagnosis and prompt treatment are important for the improvement of prognosis.