巩膜炎和表层巩膜炎临床特征与诊疗分析

Clinical features and visual outcomes of the patients with scleritis and episcleritis

目的通过回顾性病例分析，旨在了解巩膜炎和表层巩膜炎患者的临床特征、相关全身疾病、诊治效果以及与视力预后相关的因素。方法自2006年1月至2012年6月间，共收治各类巩膜炎68例和表层巩膜炎11例，共有患者79例，其中男31例，女48例；平均发病年龄（44．1±15．9）岁（16—69岁）。分析所有患者的临床表现、视力变化和全身相关疾病情况，主要治疗措施包括局部使用糖皮质激素和非甾体抗炎剂，部分患者给予全身糖皮质激素、非甾体抗炎剂或其他免疫抑制剂治疗。结果在79例患者中，单眼发病者61例（77．2％），双眼发病者18例（22．8％），女性略多见（60．8％）；表层巩膜炎11例（13．9％），巩膜炎68例（86．1％）；在各类巩膜炎和表层巩膜炎患者中，弥漫性前巩膜炎37例（46．8％），结节性前巩膜炎15例（19．0％），坏死性巩膜炎4例（5．1％）和后巩膜炎12例（15．2％），表层巩膜炎11例（13．9％）。合并前葡萄膜炎者25例（31．6％），合并眼压升高者16例（20．3％），伴有全身疾病者23例（29．1％）。有36例患者（45．6％）给予全身糖皮质激素治疗，16例患者（20.3％）联合其他免疫抑制剂治疗。多数患者经治疗后视力预后良好，治疗后最佳矫正视力低下的相关因素有坏死性巩膜炎（OR=4．01，P〈0．01）、3级以上巩膜炎症（OR=2．24，P〈0．01）、后巩膜炎（OR=2．13，P〈0．05）、伴发全身疾病（OR=1．57，P〈0．05）和伴发前葡萄膜炎（OR=1．25，P〈0．05）。结论巩膜炎患者多合并有全身疾病，且反复发作，表层巩膜炎和部分前巩膜炎患者视力预后良好，少数顽固性患者需全身给予糖皮质激素或其他免疫抑制剂治疗。

Objective To evaluate the clinical characteristics, the associated systemic diseases, the treatment outcomes and prognostic factors of the patients with scleritis and episcleritis. Meth ods Medical records were retrospectively reviewed for 79 patients with scleritis and episeleritis who presented between 2006 and 2012. Forty-eight patients were female and 31 were male. The mean age at presentation was 47.34±18.7 years old （ranged 16-69 years）. The clinical features, the best cor- rected visual acuity, the systemic disease association, the treatment outcomes and ocular complica- tions were analyzed. The main treatments included the topical or systemic nonsteroidal anti-inflamma- tory drugs and corticosteroids. Some patients were treated with additional immunosuppressive agents. Results Of the 79 patients, the unilateral involvement occurred in 61 patients （77.2%） and bilateral involvement in 18 patients （22.8%）. There was a slight predominance of women （60.8%）. There were 11 cases （13.9%） with episcleritis and 68 cases （86.1%） with scleritis. Among the scleritis, there were 37 cases （46.8%） with diffuse anterior scleritis, 15 cases （19.0%） with nodular anterior scleritis, 4 cases （5.1%） with necrotising anterior scleritis and 12 cases （15.2%） with posterior scleri- tis. There were 25 cases （31.6%） combined with anterior uveitis, 16 cases （20.3%） with ocular hyper- tension and 23 cases （29.1%） associated with systemic diseases. Thirty-six cases （45.6%） of patientswere treated with systemic corticosteroids and 16 cases （20.3%） were combined with immunosuppres- sive agents. The visual outcomes were generally good in most patients, the risk factors for the poor- er visual outcomes included necrotizing scleritis （OR=4.01, P 〈0.01）, degree of scleral inflammation of more than level 3 （OR=2.24, P 〈0.01）, posterior scleritis （OR=2.13, P 〈0.05）, association with systemic disease （OR=1,57, P 〈0.05） and combined with anterior uveitis （OR=1.25, P 〈0.05）. Con- clusions Scleritis is a form of recurrent ocular inflammation frequently associated with systemic auto- immune diseases. Most of the episcleritis and some anterior scleritis are achieved the good prognos- tic visual outcomes. Some of the refYactory patients need to receive the oral corticosteroids or immu- nosuppressive drugs to control the recurrent inflammation.