获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎诊治分析

Cytomegalovirus retinitis associated with acquired immunodeficiency syndrome

目的 分析获得性免疫缺陷综合征（AIDS）合并巨细胞病毒性视网膜炎（CMVR）的临床特征和治疗预后.方法 对2003～2010年在郑州市第二人民医院眼科确诊为AIDS合并CMVR的患者共34例49只眼,进行常规视力、裂隙灯检查、间接眼底镜、九方位眼底彩色照相、荧光素眼底血管造影（FFA）,外周血CD4＋T细胞计数,血清CMV抗体检测.总结眼底病变的临床特点,分析病变的可能影响因素.其中16例24只眼进行玻璃体内注射更昔洛韦治疗,随访观察6个月至1年.结果 视力＜0.1者34只眼（其中无光感6只眼,手动7只眼,指数8只眼）;0.1～0.5者11只眼;＞0.5者4只眼.眼底检查29只眼视网膜上见大片融合性黄白色坏死灶,边界不清,伴视网膜出血及血管炎改变,其FFA示晚期病灶区域弥漫性荧光素渗漏;12只眼周边部视网膜颗粒状坏死灶,边界欠清,未见明显视网膜出血、渗出及血管管壁改变,FFA示病灶区域强荧光,晚期荧光素渗漏;4只眼视网膜前见大片灰白色增殖膜;4只眼继发视网膜脱离.13只眼治疗后视力提高,眼底病变萎缩,出血吸收.结论 CMVR主要表现为进行性坏死性的视网膜炎,伴出血及血管炎.玻璃体注射更昔洛韦治疗对CMVR有较好效果.

Objective To investigate the fundus characteristics and therapeutic outcomes of cytomegalovirus retinitis （CMVR） associated with acquired immunodeficiency syndrome （AIDS）.Methods Thirty-four patients （49 eyes） with AIDS and CMVR were included in the study from department of Ophthalmology,Zhengzhou Second Renmin Hospital during 2003-2010.Visual acuity,slit lamp ophthalmoscopy,indirect ophthalmoscope,fundus photography,fundus fluorescence angiography （FFA）,CD4＋T-lymphocyte counts,CMV antibody were measured.Intravitreal injection of ganciclovir was performed in 16 patients （24 eyes）.The follow-up time was 6-12months.Results Visual acuity of the patients was as following：〈0.1,34 eyes; 0.1-0.5,11 eyes; 〉0.5,4 eyes.Representative CMVR was characterized by full thickness,yellow-white,confluent granular retinal necrosis with hemorrhage,vessel sclerotic and attenuated in 29 eyes.FFA showed fluorescein leakage in late phase.Unrepresentative CMVR was demonstrated in 12 eyes,recognized as granular retinal necrosis located in peripheral retina.Hemorrhage and effusion was not obvious.Pre-retina membrane was found in 4 eyes and retinal detachment in 4 eyes.After intravitreal injection of ganciclovir,visual acuity was improved,fundus lesions shrinked and hemorrhage was absorbed in 13 eyes.Conclusions CMVR has a distinctive manifestation with thickness,yellow-white retinal lesions,hemorrhage and retinal vasculitis.Intravitreal injection of ganciclovir is therapeutic for CMVR.