霉菌性坏死性视网膜脉络膜炎的临床病理研究

Clinicopathologic study on fungal necrcotizing retinochoroiditis

目的 探讨霉菌性坏死性视网膜脉络膜炎的临床表现和组织病理学改变。 方法 收集因霉菌性视网膜脉络膜炎患眼失明的患者７例（７只眼），摘除的眼球用ＨＥ、ＰＡＳ和六胺银染色，光镜观察，２例２只眼部分标本用透射电镜观察。患者血和病变组织作霉菌培养。 结果 患者球结膜深充血，房水和玻璃体明显浑浊，视网膜弥散出血和灰白色浑浊物，甚者视网膜脱离。病理学发现视网膜内出血，视网膜脉络膜组织坏死，血管内、病变区和玻璃体中有菌丝存在。４例血霉菌培养３ 例阴性，５例５ 只眼病变组织培养均阳性。 结论 机体免疫功能严重受损可引起血源性视网膜脉络膜霉菌感染，造成视网膜脉络膜严重破坏，导致患者失明。

Objective To investigate the clinical manifestation and histopathologic changes of the fungal necrotizing retinochoroiditis. Methods Collecting 7 cases of fungal retinochoroiditis with severe immunodepression and loss of visual acuity.Seven removed eyeballs were stained with HE,PAS and silver methenamine,and observed by light microscopy,and in addition,2 of them examined by electron microscopy.Also fungal cultures of blood and affected tissues were performed. Results The chief clinical macnifestation included ciliary injection of conjunctiva,opaque aqueous fluid and vitreous and diffuse hemorrhage and greyt white opacity with retinal detachment in severe cases.Pathologic changes included hemorrhage in the retina,chorioretinal tissue necrosis,hyphae in the blood vessels,affected tissue and vitreous.Fungal culture of blood was positive in three cases.Culture of affected tissues was positive in all cases. Conclusions Eedogenous fungal infection of choroid and retina may be due to the severe immunodepression of the sufferers and usually causes chorioretinal tissue destruction and blind.