获得性梅毒葡萄膜炎临床研究现状与进展

Clinical research status and progress of acquired syphilis uveitis

获得性梅毒葡萄膜炎缺乏特征性临床表现,可表现为多种类型的葡萄膜炎;最常见的类型是后葡萄膜炎和全葡萄膜炎,包括脉络膜视网膜炎、视网膜血管炎、视神经视网膜炎等.获得性梅毒葡萄膜炎的确诊和治疗反应评估主要依赖于血清学检测,包括非梅毒螺旋体和梅毒螺旋体试验.获得性梅毒葡萄膜炎可模仿多种类型葡萄膜炎,应注意与免疫性葡萄膜炎及其他感染性葡萄膜炎相鉴别.具有活动性临床表现的眼部梅毒,应按照神经梅毒治疗方案进行抗生素治疗,首选青霉素G治疗,过敏者选用多西环素.临床往往因为误诊和漏诊而延误治疗,导致不可逆的视力损害和严重的全身及眼部并发症;如治疗及时,其预后较好.

Acquired syphilis uveitis,due to lack of the characteristic features,presents with various types.The most common type is posterior uveitis and panuveitis,including chorioretinitis,retinal vasculitis,optic nerve retinitis.The diagnosis and assessment of response to treatment depends mainly on the serological diagnostic tests,including nontreponemal and treponemal test.Acquired syphilis uveitis often presents with manifestations similar to various types of uveitis,especially to autoimmune uveitis and other infectious uveitis,so differential diagnosis is important.The gold standard treatment for active syphilitic uveitis is penicillin G,or doxycycline if patient is allergy to penicillin.Clinically misdiagnosis and delayed treatment may result in irreversible visual impairment and severe systemic and eye complications.However such timely treatment always has a good prognosis.