视盘水肿型和视网膜浆液性脱离型急性期Vogt-小柳-原田综合征临床特征对比观察

The clinical features of acute Vogt-Koyanagi-Harada syndrome with optic disc edema and serous retinal detachment

目的对比观察视盘水肿(ODS)型和浆液性视网膜脱离(RD)型急性Vogt-小柳-原田综合征(VKH综合征)患者的临床特征。方法回顾性临床研究。2013年1月至2019年11月于上海市徐汇区中心医院眼科确诊为急性期VKH综合征的212例患者424只眼纳入研究。其中,男性105例210只眼,女性107例214只眼;平均年龄(40.84±13.90)岁。患眼均行BCVA、FFA、OCT检查。采用标准对数视力表行BCVA检查,统计时换算为logMAR视力。依据眼底改变,将患者分为ODS型组和RD型组,分别为36例72只眼(16.98%)和176例352只眼(83.02%)。两组患者发病年龄、就诊时间和BCVA比较行独立样本t检验;计数资料比较行χ2检验。结果ODS型组36例72只眼中,男性16例32只眼(44.44%),女性20例40只眼(55.56%);平均年龄(40.56±16.57)岁;平均就诊时间(22.47±19.98)d;平均logMAR BCVA 0.68±0.53。RD型组176例352只眼中,男性89例178只眼(50.56%),女性87例174只眼(49.43%);平均年龄(40.90±13.34)岁;平均就诊时间(17.25±24.40)d;平均logMAR BCVA 0.80±0.56。两组患者平均年龄(t=-0.116)、性别构成比(χ2=0.448)、平均就诊时间(t=1.204)、平均logMAR BCVA(t=-1.661)比较,差异均无统计学意义(P>0.05)。ODS型、RD型组患者不同眼别之间平均logMAR BCVA比较,差异均无统计学意义(t=0.227、0.810,P>0.05)。ODS型、RD型组患眼中伴有眼前节炎症者分别为50(69.44%,50/72)、272(77.27%,272/352)只眼;两组比较,差异无统计学意义(χ2=1.003,P>0.05)。ODS型、RD型组患者中伴有头痛、听力下降者分别为2(5.56%,2/36)、34(19.32%,34/176)例;两组比较,差异有统计学意义(χ2=4.015,P<0.05)。结论与ODS型急性期VKH综合征患者比较,浆液性RD型急性期VKH综合征患者更容易出现头痛、听力下降等眼外症状。

Objective To compare the clinical features of patients with acute Vogt-Koyanagi-Harada syndrome (VKH syndrome) of optic disc swelling (ODS) and serous retinal detachment (RD).Methods A retrospective clinical study. From January 2013 to November 2019, 212 patients with acute VKH syndrome diagnosed in the Department of Ophthalmology of Shanghai Xuhui District Central Hospital were included in the study. Among them, there were 105 males (210 eyes) and 107 females (214 eyes). The average age was 40.84±13.90 years. All affected eyes were examined by BCVA, FFA, and OCT. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity in statistics. According to the changes in the fundus, the patients were divided into the ODS group and the RD group, 36 patients with 72 eyes (16.98%) and 176 patients with 352 eyes (83.02%), respectively. The independent sample t test was performed to compare the age of onset, visit time and BCVA of the two groups of patients, the χ2 test was performed to compare the count data.Results Among the 72 eyes of 36 patients in the ODS group, there were 16 males with 32 eyes (44.44%), 20 females with 40 eyes (55.56%). The average age was 40.56±16.57 years, the average visit time was 22.47±19.98 days, the average logMAR BCVA was 0.68±0.53. Among the 352 eyes of 176 patients in the RD group, there were 89 male patients with 178 eyes (50.56%), and 87 female patients with 174 eyes (49.43%). The average age was 40.90±13.34 years, the average visit time was 17.25±24.40 days, the average logMAR BCVA was 0.80±0.56. The average age (t=-0.116), gender composition ratio (χ2=0.448), average visit time (t=1.204), average logMAR BCVA (t=-1.661) comparisons between the two groups showed no statistically significant differences (P>0.05). There was no statistically significant difference in the average logMAR BCVA between the RD group and the ODS group of different eyes (t=0.227, 0.810;P>0.05). There were 50 (69.44%, 50/72) and 272 (77.27%, 272/352) eyes in the ODS group and RD group with inflammation of the anterior segment. There were anterior segment reactions between the two groups. There was no statistically significant difference in the number of eyes (χ2=1.003, P>0.05). There were 34 (19.32%, 34/176) and 2 (5.56%, 2/36) patients with headache and hearing loss, respectively. The comparison of the number of patients with headache and hearing loss between the two groups showed statistically significant differences (χ2=4.015, P<0.05).Conclusion Compared the patients with ODS acute VKH syndrome, the patients with serous RD acute VKH syndrome are more likely to have extraocular symptoms such as headache and hearing loss.