病毒性角膜葡萄膜炎58例临床分析

Clinical analysis of 58 cases of herpetic keratouveitis

目的探讨疱疹病毒性角膜葡萄膜炎的临床特点、诊断、治疗方法及其预后。方法收集2003年1月-2007年12月疱疹病毒性角膜葡萄膜炎患者58例，均为单眼发病；其中男39例，女19例；年龄16～63岁，平均（38．5±12．9）岁，依据其临床资料和实验室检查结果，对其临床特征、诊断、治疗和视力预后进行分析。结果58例患者中有16例伴发角膜实质炎，12例伴发树枝状角膜炎，9例伴发带状疱疹病毒感染；31例（53．4％）患者眼压升高。经过2～4周的抗炎及抗病毒治疗后，54例（93．1％）患者角膜虹膜炎症消失，眼压降至正常，视力恢复。3例（5．2％）患者因角膜云翳致视力减退。1例患者（1．7％）发生角膜穿孔，最终因角膜变性和粘连性白斑而致盲。结论病毒感染可导致角膜葡萄膜炎和小梁网炎，并引起眼压升高，通过积极抗炎和抗病毒治疗，可迅速控制炎症及眼压。

Objective Present study was to explore the clinical characteristics, diagnosis, treatment and visual outcomes in patients with uveitis caused by herpetic virus. Methods The clinical data was retrospectively studied in 58 patients with uveitis caused by herpetic virus. The patients were managed in Tianjin Eye Hospital from January 2003 to December 2007. The clinical manifestation of the disease, serological diagnosis,medical treatments and visual acuity outcmnes were analyzed. Results Among the 58 cases of patients,the males were 39 cases and the females were 19 cases. The average age was 38.5 years old. The diagnosis included corneal stromal keratitis in 16 cases, corneal epithelial keratitis in 12 cases and herpes zoster ophthalmicus in 9 cases. Secondary glaucoma was found in 31 cases （53.4%）. After the treatment with topical corticosteroids and antiviral agents, 54 cases（93. 1% ） of patients recovered with good vision acuity,and the intraocular pressure was normal. The visual acuity was declined in 3 cases （5.2%） because of partial corneal scarring. One case （ 1.7% ） was blinded owing to perforation and degeneration of cornea. Conclusion The herpetic virus infection could cause keratitis,keratouveitis and trabeculitis,and the secondary glaucoma is common complication. The application of topical corticosteroids and antiviral agents is helpful for the recovery of diseases.