交感性眼炎临床研究现状

Current clinical research of sympathetic ophthalmia

交感性眼炎是一眼发生眼球穿孔伤或内眼手术后引起的罕见的双眼非坏死性肉芽肿型葡萄膜炎。发病机制目前尚未完全清楚,多认为是外伤眼(刺激眼)引起的自身免疫反应导致交感眼发病。交感性眼炎临床表现多变,病情易于反复恶化,并可能致盲。早期发现,及时治疗可以达到令人满意的视力预后。药物治疗主要为全身应用糖皮质激素及免疫抑制剂,生物调节剂可作为对常规药物治疗不敏感的难治性交感性眼炎的二线用药,局部给药包括曲安奈德玻璃体腔注射及眼内植入氟轻松缓释剂。手术治疗可采用眼球摘除术或眼内容物剜出术。但是手术方式及手术时机的选择,目前仍存在争议。由于交感眼的远期视力可能低于刺激眼,摘除刺激眼需谨慎执行。

Sympathetic ophthalmia（SO） is a rare,bilateral,non-necrotizing,granulomatous uveitis of both eyes following ocular trauma or surgical procedures to one eye.The pathophysiology is not clearly understood,but it appears that the inciting eye leads to an autoimmune hypersensitivity reaction against the exposed ocular antigens in the injured eye as well as in the sympathizing eye.Although the clinical manifestations of SO is variable and vulnerable for deterioration or even blindness,most patients can expect to have relatively good visual acuity with prompt medical attention and treatment.The mainstay of medicinal treatment is systemic use of corticosteroid and immunomodulators.Biomodulators have been proposed as a second-line strategy after failure with conventional immunosuppressants for the treatment of refractory SO.Topical drug administration,including intravitreal triamcinolone acetonide（IVTA） and implantation of the fluocinolone acetonide（Retisert） implant,can also be considered.There is controversy about whether enucleation or evisceration is more appropriate and when the procedure should be done.The decision of enucleation or not needs to be made very carefully since the vision in the inciting eye may be better than the vision in the sympathetic eye in the long term.