伴有高眼压的前葡萄膜炎诊治中的一些问题

Several issues for the diagnosis and treatment of anterior uveitis with increased intraocular pressure

某些缺乏严重纤维素性渗出及虹膜后粘连的前葡萄膜炎如病毒性前葡萄膜炎、Fuchs综合征、青光眼睫状体炎综合征等均可表现为持续性或反复性眼压升高,对其治疗常较棘手。最近,新加坡学者对巨细胞病毒性前葡萄膜炎进行了系统分析,对伴有眼压升高的前葡萄膜炎患者提出了新的诊治思路。虽然Fuchs综合征、青光眼睫状体炎综合征与巨细胞病毒性前葡萄膜炎有类似表现,且后两者的发病机制中均有提到巨细胞病毒,但针对后两者的治疗目前仍以对症治疗为主,是否需加入抗病毒治疗,仍需长期的实践探讨。

Some anterior uveitis lack of severe fibrinous exudation and posterior synechiae of iris, such as viral anterior uveitis, Fuchs syndrome and Posner-Schlossman syndrome, can be manifested as persistent or recurrent elevated intraocular pressure, and its treatment is often difficult. Recently, Singapore scholars described clinical features of cytomegalovirus anterior uveitis in immuocompe- tent patients, and presented a new idea to diagnosis and treatment of the anterior uveitis with ocular hypertension. Though Fuchs syn- drome and Posner-Schlossman syndrome have similar clinical manifestations to cytomegalovirus anterior uveitis, and cytomegalovirus infection may be the pathogenesis of the two diseases, whether to join the antiviral therapy for the Fuchs syndrome, Posner-Schlossman syndrome or not, is still a problem worthy of discussion. （Ophthalmol CHN, 2012, 21： 228-233）