急性闭角型青光眼为首发症状的VKH综合征分析

Acute angle-closure glaucoma as an initial symptom of Vogt-Koyanagi-Harada disease

目的 以急性闭角型青光眼大发作为首发症状的Vogt小柳原田综合征的临床特点、治疗及预后进行分析.方法 对2009年1月1日至2014年12月31日在西安市第四医院眼科治疗和随访的患者共9例18只眼的资料进行回顾性分析.所有患者均予以糖皮质激素治疗,在治疗前后不同的时间点进行裂隙灯和眼底检查,UBM、OCT眼底荧光血管造影检查,对检测结果进行对比分析.结果 所有患者首次就诊时均表现为眼压升高、浅前房、窄房角或房角关闭,平均眼压（30.6＆#177;12.6） mmHg,视力为眼前指数～0.6,平均发病年龄为48.6岁.9例患者中有8例均被误诊为急性闭角型青光眼,4例行激光虹膜周边切除术,误诊为青光眼患者对降眼压药物反应欠佳,而经过糖皮质激素等系统治疗后,炎症均得到了控制,眼压控制良好,视力明显提高.治疗后,UBM示睫状体脱离复位,OCT示视网膜神经上皮脱离逐渐平复,视盘水肿消失.眼底血管造影示无异常荧光素渗漏.结论 以急性闭角型青光眼大发作为首发症状的Vogt小柳原田综合征极易误诊,临床确诊后,应用糖皮质激素长效、足量治疗,能够取得较好的疗效.

Objective To report atypical ocular manifestations of Vogt-Koyanagi-Harada syndrome presented with acute angle closure glaucoma.Methods An observational study.Results Visual acuity ranged from figures count to 0.6.Intraocular pressure ranged from 25 to 38 mmHg with slight anterior chamber inflammation.Mild vitritis and massive exudative retinal was seen,ciliary body detachment was observed.B scan,UBM and fundus fluorescein angiography supported the diagnosis.After corticosteroid treatment,the increased intraocular pressure was resolved with deepened anterior chamber and open angle.Inflammation was controlled,ciliary body and retinal detachment was reset and visual acuity was improved.Conclusions These patients present with acute increasing intraocular pressure and closed angle as initial symptom of Vogt-Koyanagi-Harada syndrome.Systemic corticosteroid therapy may obtain complete remission of the ocular inflammatory activity.