甲基强的松龙治疗葡萄膜炎的疗效观察

Therapeutic effect of methylprednisolone systemic and local application for uveitis

目的:评价全身及眼局部联合应用甲基强的松龙治疗葡萄膜炎的疗效。方法:回顾性分析于中国医科大学附属第一医院眼科就诊并诊断为葡萄膜炎的患者86例157眼,应用甲基强的松龙500～1000mg全身静点冲击3～5d,后改为强的松1mg/(kg.d)口服,并且逐渐减量;患眼局部应用甲基强的松龙40mg球后注射连续3～5d,并逐渐减量,依据患者病情调整用药,观察治疗前后患者最佳矫正视力(BCVA)、眼底镜下所见葡萄膜炎和渗出性视网膜脱离恢复情况、眼底血管荧光造影荧光渗漏情况及OCT检查后极部视网膜厚度变化情况。结果:至随访期末,BCVA提高>2行者128眼(81.5%),BCVA无变化16眼(10.2%),BCVA下降13眼(8.3%);葡萄膜炎及渗出性视网膜脱离完全或基本消退者149眼(94.9%);眼底荧光血管造影渗漏完全或基本消失者131眼(83.4%);OCT检查后极部视网膜厚度降低者134眼(85.4%),不变者14眼(8.9%),后极部视网膜厚度增加者9眼(5.7%)。结论:应用甲基强的松龙治疗葡萄膜炎疗效确切,可有效控制葡萄膜炎症,提高视功能。

AIM：To observe the clinical effects of methylprednisolone systemic and local application for uveitis.METHODS：Eighty-six 86 cases（157 eyes） of uveitis patients were analysed retrospectively and treated at the Ophthalmology Department of the First Hospital of China Medical University.Methylprednisolone 500-1 000 mg was transfused per day for stoss during the first 3-5 days,and then changed to prednisone 1mg/kg·d orally,and decrement gradually.Methylprednisolone 40mg was locally applicated by injection behind the eyeball during the first 3-5 days,and then decrement gradually,adjusting the medication according to patient＇s condition.The best-corrected visual acuity（BCVA）,the recovery of uveitis and exudative detachment of retina by ophthalmoscope,the fluorescence leakage of FFA and macular retinal thickness by OCT were observed before and after the treatment.RESULTS：At the end of the follow-up period,the BCVA improved in 128 eyes（81.5%）,remained unchanged in 16 eyes（10.2%）,and degraded in 13 eyes（8.3%）;the uveitis and retina detachment were recovery in 149 eyes（94.9%）;the leakage of FFA were no or little in 131 eyes（83.4%）;the macular retinal thickness by OCT examination were lower in 134 eyes（85.4%）,14 eyes（8.9%） were unchanged and 9 eyes（5.7%） were aggravated.CONCLUSION：The systemic and local application of methylprednisolone for uveitis is effective,which can effectively control the uveitis and improve visual function.