急性视网膜坏死综合征的治疗

Treatment of the Acute Retinal Necrosis Syndrome

目的探讨急性视网膜坏死综合征(acute retinal necrosis syndrome, ARN)治疗的时机、方式及疗效.方法对急性视网膜坏死综合征35例52只眼进行药物、激光和手术治疗,分析治疗时机与结果之间的关系.结果开始用药时间在发病2周以内的22只眼中17只眼(77%)未发生视网膜脱离,视力保持在0.3以上的有14只眼;药物加光凝治疗的31眼中,仅12只眼(39%)未发生视网膜脱离,但4只眼因玻璃体增生性病变严重(视网膜脱离的高危状态)而行玻璃体视网膜手术.玻璃体视网膜手术的24只眼中,有20只眼视网膜复位尚好;术前已有视网膜脱离的18只眼术后视力均在光感～0.05;无视网膜脱离的6只眼,术后视力在0.05～0.2之间.结论及时的药物、激光光凝、玻璃体视网膜手术对ARN的治疗是必要的;应在视网膜脱离发生以前进行视网膜玻璃体手术.

Objective To analyze the treatment timing and efficacy of acute retinal necrosis (ARN) syndrome. Methods 35 patients (52 eyes) diagnosed with ARN syndrome undergoing systemic medication, retinal photocoagulation and vitreous surgery were reviewed retrospectively to evaluate the timing and efficacy of the treatment. Results In the patients who took medicine atthe first 2 weeks, 17 of 22 eyes (77%) avoided retinal detachment and 14 eyes had a final visual acuity better than 0.3. Nevertheless, only 12 of 31 eyes (39%) with medicine and retinal photocoagulation were spared from retinal detachment, and 4 eyes underwent vitrectomy for sever proliferative vitreoretinopathy. Retinal reattachment was achieved in 20 of the 24 eyes with vitrectomy. 18 eyes of those with retinal detachment before surgery had visual acuity from light perception to 0.05, others from 0.05 to 0.2. Conclusion It is suggested that prompt treatments, such as medication, retinal photocoagulation and vitrectomy are important managements to ARN syndrome. The visual outcome suggests that the eyes without retinal detachment have better effect. Vitrectomy should be considered before retinal detachment.