Vogt-小柳-原田综合征葡萄膜炎期眼底病变特征

Fundus lesions character of uveitis stage of Vogt-Koyanagi-Harada syndrome

目的探讨Vogt-小柳-原田综合征(VKH)葡萄膜炎期眼底病变的临床特征。方法对首诊VKH患者71例(142眼)治疗前视力、病程、眼底及荧光素眼底血管造影(FFA)检查进行分析;25例(50眼)进行光学相干断层扫描(OCT)检查。结果71例(142眼)眼底有3种表现:32眼(22.5%)视盘水肿较重,视网膜脱离较轻(视盘型);47眼(33.1%)视网膜脱离较重,视盘无水肿,仅表现为轻度充血(脉络膜型);63眼(44.4%)视网膜脱离较重,视盘水肿亦较重(混合型)。3型年龄差异无统计学意义(F=2.57,P=0.084);3型病程差异无统计学意义(F=0.91,P=0.407);治疗前视力:视盘型与脉络膜型及混合型组间差异有统计学意义(t=4.49,P<0.01;t=3.38,P=0.001),脉络膜型与混合型组间差异无统计学意义(t=0.04,P=0.971)。结论VKH葡萄膜炎期的眼底表现可有3种类型。脉络膜炎性渗出及视网膜脱离是视力损害的主要因素,而视盘水肿视力损害较轻。3种类型的表现形式与年龄和病程间无相关。

Objective There were various clinical features and disease course progress in Vogt-Koyanagi-Harada （VKH） , and the fundus lesions were remarkable different in the early uveitis stage. It is very important to accurately understand the fundus lesions in the early uveitis stage of VKH. The goal of this study was to research the fundus lesions in uveitis stage of VKH syndrome. Methods The visual acuity,disease history,fluoreseein fundus angiography （FFA） were analysed in 142 eyes of 71 cases with uveitis stage of VKH syndrome before treatment. OCT was examined in 50 eyes of 25 patients. These patients had a definite diagnosis based on the Revised Diagnostic Criteria for Vogt-Koyanagi-Harada Disease reported by an International Committee on Nomenclature. Results There were 3 kinds of fundus manifestations in 142 eyes,including disc-type of VKH 32 eyes （16 eases,22.5% ） ,choriod-type of VKH 47 eyes （24 cases,33. 1% ） and mixed-type of VKH 63 eyes （31 cases, 44. 4% ）. Disc-type of VKH showed heavier edema of optic disc but more mild extent of retinal detachment, and choroidal type of VKH presented heavier retinal detachment and mild congestion of optic disc. In 63 eyes with mixed-type of VKH, the retinal detachment and edema of optic disc were heavier. No significant difference was found in age and disease history among 3 types of VKH （ F = 2.57 ,P = 0. 084 ; F = 0. 91, P = 0. 407 ）. A significant difference was found in vision between disc type and ehoroidal type or mixed-type （t = 4.49, P 〈 0. 001;t = 3.38,P = 0. 001 ）, but no significant difference was seen between ehoroidal type and mixed-type VKH（t = 0. 04, P = 0. 971 ）. Conclusion Uveitis stage of VKH can be classified into three kinds of fundus appearances. The vision damage of uveitis is associated to exudation of choroidal vessel and extent of retinal detachment rather than edema of optic disc. The patterns of clinical manifestation was not related with age and history.