前葡萄膜炎临床诊治分析

The diagnosis and treatment analysis of anterior uveitis

目的探讨前葡萄膜炎患者的临床特点、治疗效果、视力预后和诊治中存在的问题。方法回顾性系列病例研究。自2012年10月至2013年6月间，收集于天津市眼科医院就诊的各类前葡萄膜炎患者109例，男52例，女57例；平均发病年龄（41±15）岁。通过临床检查、实验室检查和诊治观察，对其临床类型、疗效、并发症和视力预后进行分析。结果109例患者中，急性前葡萄膜炎39例（35．8％），慢性前葡萄膜炎15例（13．8％），复发性前葡萄膜炎55例（50．5％）。根据病因分为特发性前葡萄膜炎52例（47．7％），病毒性前葡萄膜炎11例（10．1％），Fuehs综合征5例（4．6％），青光眼睫状体炎综合征3例（2．8％）；合并血清阴性脊柱关节病22例（20．2％）、糖尿病8例（7．3％）、类风湿性关节炎4例（3．7％）和幼年性关节炎3例（2．8％），结核病1例（0．9％）。各种并发症发生率为34．9％（38例），轻度视力损害（低于0．5）发生率为7．3％（8例），中重度视力损害（低于0．3）为6．4％（7例），致盲率（低于0．05）为1．8％（2例）。结论前葡萄膜炎临床类型多样，特发性前葡萄膜炎、血清阴性脊柱关节病伴发前葡萄膜炎及病毒性前葡萄膜炎为常见类型。急性前葡萄膜炎易复发，但视力预后较好，慢性或顽固性炎症常导致严重视力损害或致盲。

Objective To investigate the clinical characters, effects of treatment, prognosis of vi- sual acuity and the problems in the treatment of anterior uveitis patients. Methods The retrospec- tive ease series study. Collecting 109 cases of anterior uveitis from October 2012 to June 2013 in Tianjin Eye Hospital, there were 52 cases of male and 57 cases of female. The mean age was （41q- 15） years old. Through clinical examination, laboratory tests and treatment observation, the clinical characters, effects of treatment, complications and prognosis of the anterior uveitis were analyzed. Results In 109 patients, there were 39 cases （35.8%） with acute anterior uveitis, 15 （13.8%） with re- current anterior uveitis and 55 （50.5%） with chronic anterior uveitis. There were 52 cases （47.7%） with idiopathic uveitis, 11 （10.1%） with herpetic uveitis, 5 （4.6%） with Fuchs syndrome and 3 （2.8%） with glaucomatocyclitic crisis, 22 （20.2%） with seronegative spondyloarthropathy, 8 （7.3%） with diabetes mellitus, 4 （3.7%） with rheumatoid arthritis and 3 （2.8%） with juvenile idiopathic arthri- tis based on the etiological classification. The rate of complications was 34.9% （38 cases）, the mild visual impairment （less than 0.5） was 7.3% （8 cases）, the moderate and severe visual impairment （less than 0.3） was 6.4% （7 cases）, and the blindness （less than 0.05） was 1.8% （2 cases）. Conclu- sions The types of anterior uveitis are varied. Idiopathic anterior uveitis, seronegative spondyloar- thropathy associated uveitis and herpetic uveitis are the common entities. Acute anterior uveitis is easy to relapse, but vision prognosis is often good, but the chronic inflammation often leads to the severe visual impairment or blindness.