特发性视网膜血管炎综合治疗的疗效分析

The clinical observation of comprehensive therapy for idiopathic retinal vasculitis

目的分析特发性视网膜血管炎的治疗效果。方法对126例(197眼)确诊为特发性视网膜血管炎的患者进行药物、激光或玻璃体手术治疗进行回顾性分析,包括1年内的视力、光学相干断层扫描(OCT)检查、荧光素眼底血管造影(FFA)结果。结果早期药物治疗110眼,其中视力改善者61眼(55.5%),需激光或手术治疗者36眼(32.7%)。激光治疗累计71例(119眼),视力改善者88眼(73.9%)。20眼接受玻璃体手术,视力改善者9眼(45%)。接受激光与玻璃体手术治疗的疗效比较差异有统计学意义(χ2=6.80,P<0.05)。非玻璃体出血与玻璃体出血者激光治疗后视力改善眼数的差异有统计学意义(χ2=6.53,P<0.05)。对视力改善者,OCT和FFA均提示黄斑水肿明显改善。结论视网膜激光光凝对特发性视网膜血管炎是重要的治疗手段,不同治疗方法适应证的选择和治疗期间的密切随访对于改善治疗效果至关重要。

Objective Idiopathic retinal vasculitis is one of juveniel blindness ocular diseases. The choose of therapy for idiopathic retinal vaseulitis aimed at the complication due to unclear pathogenesis. This paper was to evaluate the clinical effectiveness of different therapies for idiopathic retinal vasculitis. Methods This study was a retrospective analysis of cases. 197 eyes of 126 cases with idiopathic retinal vasculitis received systemic medicine,laser photocoagulation of fundus or vitrectomy in Henan Eye Institute from January 2005 to December 2006. The clinical data of these patients was collected and analysed, including visual acuity, OCT and fundus fluorescein angiography （FFA） within 1 year. Results In 110 eyes treated with medicine,visual acuity of 61 eyes（55.5% ） was improved and 36 eyes （32. 7% ） needed laser photocoagulation of fundus or vitrectomy. Visual acuity of 88 （73.9%） of 119 eyes received laser therapy was improved after photocoaguahion of fundus, and that of 9（45% ） in 20 eyes underwent vitreetomy was improved. There was a significant difference in the visual improved eyes numbers between photeoagulation and vitrectomy （X^2 = 6.80, P 〈 0. 05 ）. The significant difference was aslo been seen in the numbers of eyes vision increase after vitrectomy between the eyes with and without vitrous hemorrhage （X^2 = 6.53 ,P 〈 0. 05 ）. The maeular edema was obviously relieved on the OCT and FFA in the eyes with progression of visual acuity. Conclusion Laser coagulation is a good therapy for idiopathic retinal vaseulitis. The selection of indication for different therapies and consecutive follow-up visit of patients are very important during the treatment.