葡萄膜炎合并黄斑囊样水肿的临床表现和治疗

Clinical features and treatment of uveitis combined with cystoid macular edema

目的探讨后葡萄膜炎患者并发黄斑囊样水肿(CME)的发生频率、临床表现和荧光素眼底血管造影(FFA)特征。方法自2002年7月至2005年6月,连续收集在我院行FFA检查的各类后葡萄膜炎患者67例106只眼,观察CME的临床表现、FFA特征和治疗效果。结果有18例患者28只眼(26.4%)出现CME改变。男7例,女11例,平均年龄(42.5±10.8)岁。FFA早期表现为黄斑区水肿遮挡脉络膜荧光而呈片状暗区,随之出现点片状渗漏,静脉期可见毛细血管扩张渗漏,后期可见荧光素蓄积在黄斑区各个小囊腔内,形成特有的花瓣状外观。18例患者分别给予糖皮质激素、非甾体抗炎药和碳酸酐酶抑制剂治疗后,黄斑水肿程度减轻,视力有不同程度改善。结论葡萄膜炎是一种严重影响视功能的眼病,其中CME明显致视力损害。早期发现和及时干预,可防止发生永久性视力损害。

Objective To explore the frequency, clinical features, and characteristics of results of fundus fluorescein angiography （FFA） of uveitis-related cystoid macular edema （CME）. Methods The clinical data and FFA results of 67 patients （106 eyes） with posterior uveitis examined in our hospital from July 2002 to June 2005 were collected. The clinical features and characteristics of FFA images of CME were observed and analyzed. Results Among the 106 eyes of 67 patients with uveitis, the CME was observed in 28 eyes （26.4%） of 18 patients, including 7 males and 11 females with the average age of （42.5± 10. 8） years. The dark area due to the choroidal fluorescence blocked by the macular edema was found at the early FFA phase, and then followed by the punctate and sheet-like leakage of fluorescein ; the capillary was dilated at the venous phase, and the typical petaloid appearance was seen at the late phase because the fluorescein cumulated in several small vesicles in the macular area. After treated by corticosteroids and topical non-steroidal anti-inflammatory medicine and carbonic anhydrase inhibitors, the extent of CME diminished, and the visual acuity improved in varying degrees. Conclusions Uveitis may seriously harm the visual function, in which CME induces the damage of visual acuity. Early detection and timely treatment may prevent the permanent visual damage.