前葡萄膜炎周边视网膜改变的临床观察

The clinical investigation of peripheral retinal changes of anterior uveitis

目的 观察前葡萄膜炎患者周边视网膜的改变.方法 回顾性系列病例研究.收集2013年9月至11月就诊于北京大学第一医院眼科的20例（33只）受累眼的前葡萄膜炎患者的临床资料.所有患者均进行常规眼科检查及超广角FFA检查.结果 20例患者中男性13例,女性7例;年龄23 ～ 66岁,平均46岁;双眼反复发作者13例,单眼反复发作7例;病程从数月至30年不等.在所有受累的33只眼中,FFA检查时炎症反应处于活动期20只眼,处于安静期13只眼.共有57.6％（19/33）的患眼出现了周边视网膜血管渗漏,其中活动期眼中75％（15/20）出现了周边视网膜血管不同程度渗漏,而炎症反应处于安静期眼中30.8％（4/13）也出现了周边视网膜血管渗漏.炎症反应活动的20只眼中6只眼出现了视乳头高荧光,另4只眼发现了黄斑囊样水肿,另外2只处于安静期眼发现了周边部视网膜强的点状高荧光及带状高荧光.结论 通过超广角FFA检查发现前葡萄膜炎患者周边视网膜血管可出现炎性渗漏,而且传统检查炎症反应处于静止期的患者仍然可能存在周边视网膜的炎症反应.

Objective To observe the peripheral retinal changes of anterior uveitis patients using ultra-wide field fluorescein angiography.Methods Retrospective case series study.Thirty-three eyes of 20 patients diagnosed as anterior uveitis from September to November 2013 in the ophthalmic clinic of Peking University First Hospital was included.All the patients underwent routine ocular examination, followed by ultra-wide field Fluorescein.Results There were 13 male patients and 7 female patients, aged 23-66, an average of 46 years old.The anterior uveitis recurrent in both eyes in 13 patients and only one eye in 7 patients.Uveitis duration ranging from months to 30 years.Twenty eyes were at the active stage of the anterior uveitis while 13 eyes in the quiescent stage.Peripheral retinal vessels leakage was detected in 57.6% （19/33） of the eyes, among which in eyes with active disease the rate of peripheral retinal vessels leakage was 75% （15/20）, and in eyes with quiescent disease the rate was 30.8% （4/13）.Optic disk hyperfluorescence was found in 6 of 20 eyes with active disease.Cystoid macular edema was found in 4 eyes.In addition, peripheral retinal hyperfluorescence dot and zone were detected in 2 eyes.Conclusions Peripheral retinal vessels were detected to have inflammative leakage in patients of anterior uveitis by ultrawide field fluorescein agiography.Peripheral retinal inflammation may still exist even in the quiescent stage of the anterior uveitis.