178例病毒性角膜炎伴发色素膜炎治疗分析

Treatment of viral keratitis associatie with uveitis of 178 Cases

目的:探讨病毒性角膜炎伴发色素膜炎的临床特点、发病机理与治疗方法。方法:对178例患者的临床资料进行分析。结果:126例盘状角膜基质炎伴发色素膜炎的患者,临床治愈123例(治愈率97.6%);随访1～5年,复发43例(复发率34.1%)。52例角膜内皮炎伴发色素膜炎的患者,临床治愈50例(治愈率96.1%);随访1～5年,复发17例(复发率32.7%)。结论:病毒是引起角膜基质炎及角膜内皮炎主要病原,而只有在复发时免疫成分才具有重要性。盘状角膜基质炎伴发色素膜炎治疗原则是加强抗病毒治疗,再适当联合糖皮质激素治疗:角膜内皮炎伴发色素膜炎治疗原则是加强糖皮质激素和免疫抑制剂(环孢霉素A)联合应用,再适当应用抗病毒药物治疗。伴发青光眼的患者以抗炎治疗为主,同时加用降眼压的药物。

Objective： To investigate the clinical characteristics, pathogenesis and treatment of viral keratitis-associated uveitis. Methods： To analyze and summarize the clinical information of 178 patients. Results： In 126 patients of disciform interstitial keratitis-associated uveitis, 123 patients were cured （97.6% of cure rate）; 43 cases were recurrent after 1 to 5 years＇ follow-up （34.1% of recurrence rate）. In 52 patients of corneal endotheliitis-associated uveitis, 50 patients were cured （a cure rate of 96.1% ）; 17 cases were recurrent after 1 to 5 years＇ follow-up （a recurrence rate of 32.7% ）. Conclusion： Viruses tend to be the major etiological agent of the interstitial keratitis and corneal endotheliitis, while only in recurrent cases, immunoagents play an important role. The therapeutic principle of interstitial keratitis-associated uveitis should be to emphasize the antiviral therapy and supplement with glucocorticold therapy is appropriate. The therapeutic principle of corneal endotheliitis-associated uveitis should be to emphasize the glucocorticoid and immunodepressant therapy （eg. Cyclosporine A ）, and supplement with antiviral therapy as appropriate. The anti-inflammatory therapy is very important to the patients of secondary glaucoma, while reducing intraocular pressure drugs were also necessary.