葡萄膜炎药物治疗中的问题分析

目的探讨葡萄膜炎临床治疗中的误区和可能原因。方法收集2000年4—10月中山大学中山眼科中心葡萄膜炎专科就诊的154例患者(268只眼)的完整资料,归纳、分析其治疗资料,尤其是糖皮质激素的给药途径、剂量和治疗时间以及抗生素应用等方面的情况。结果154例(268只眼)患者中糖皮质激素滴眼数、结膜下或球后注射眼数及全身应用例数的使用率分别为90．3％、84．0％及92．9％,而全身应用糖皮质激素的患者中静脉滴注者占85．3％。Behcet病(37例)、前葡萄膜炎(30例)及Fuchs虹膜异色性葡萄膜炎(14例)患者的既往治疗情况显示,县级、地市级和省级医院(包括省级以上医院和医学院校附属医院)的糖皮质激素应用中普遍存在着大剂量滥用或滴眼剂使用不当的现象。154例葡萄膜炎患者中抗生素滴眼数、结膜下注射眼数及全身应用例数的使用率分别为97．0％、71．6％及83．8％;仅6例(3．9％)应用了其他免疫抑制剂。结论内源性非感染性葡萄膜炎尤其是Behcet病、前葡萄膜炎及Fuchs虹膜异色性葡萄膜炎患者治疗中糖皮质激素和抗生素的滥用和误用现象相当普遍;糖皮质激素的应用途径、剂量及治疗时间应根据葡萄膜炎的类型和严重程度等而定;非感染性葡萄膜炎不需要使用抗生素。（中华眼科杂志,2004,40：679-682)

Evaluation of the problems in the treatment of uveitis

OBJECTIVE: To address the problems present in the treatment of uveitis. METHODS: A retrospective analysis was made on 154 patients (268 eyes) with different entities of uveitis, coming from all over China and referring to Zhongshan ophthalmic center from April to October of 2000. The data of these patients, especially with respect to the usage of corticosteroids and antibiotics in the referred hospitals, were analyzed. RESULTS: Corticosteroids drops, subconjunctival or retrobulbar injection and systemic corticosteroids were respectively used in 90.3% and 84.0% of these eyes, and 92.9% of these cases. Intravenous injection of corticosteroids was rather popular, accounting for 85.3% of the cases who were treated with systemic corticosteroids. Improperly aggressive treatment with corticosteroids or undue application of their eye drops was equally found in patients from county-, city- and province-level hospitals, especially in Behcet's disease, anterior uveitis and Fuchs heterochromic uveitis. Antibiotics drops, subconjunctival injection and systemic administration of antibiotics were respectively used in 97.0% and 71.6% of these eyes and 83.8% of these patients. Immunosuppressive drugs, other than the corticosteroids, were used in 6 patients only. CONCLUSIONS: Corticosteroids should be used in proper methods, dosage and duration based on the entities and severity of uveitis. It is not necessary to treat noninfectious uveitis with antibiotics.