Fuchs葡萄膜炎综合征临床特点及误诊原因分析

Clinical Characteristics and Causes of Misdiagnosis of Fuchs Uveitis Syndrome

目的探讨Fuchs葡萄膜炎综合征(FUS)的临床特点及误诊原因、防范措施。方法回顾性分析曾误诊为其他疾病的FUS 9例的临床资料。结果本组7例视力下降,其中2例伴眼胀,1例伴眼前黑影飘动;2例自觉无症状。9例最佳矫正视力4.4~5.0;皆出现虹膜脱色素和前房闪辉阳性,星状角膜后沉着物8例,瞳孔欠圆7例,晶状体密度增高6例。就诊初期外院误诊为前葡萄膜炎3例,年龄相关性白内障2例,原发性开角型青光眼合并年龄相关性白内障、前葡萄膜炎并发白内障、青光眼睫状体炎综合征和全葡萄膜炎各1例。误诊时间3 d~5年。入院后经详细病史询问结合临床资料及相关检查,确诊为FUS,给予相应治疗视力恢复良好、病情稳定。结论FUS易误诊,临床医师应加强对其认识和认真鉴别诊断,以减少或避免误诊误治。

Objective To investigate the clinical characteristics,causes of misdiagnosis,and preventive measures of Fuchs uveitis syndrome(FUS).Methods The clinical data of 9 cases of FUS who were misdiagnosed as other diseases were retrospectively analyzed.Results In this group,7 cases had decreased vision,including 2 cases with ocular distension and 1 case suffering black shadows floating in front of the eyes;2 cases were asymptomatic.The best corrected visual acuity(BCVA)was 4.4 to 5.0 in 9 cases,all of whom showed positive iridodeopigmentation and anterior chamber flicker;there were 8 cases of stellate corneal retrogression,7 cases of pupil roundness,and 6 cases of increased lens density.At the initial stage of the visit,3 cases were misdiagnosed as anterior uveitis,2 cases as age related cataract,1 case as primary open angle glaucoma with age-related cataract,1 case as anterior uveitis with cataract,1 case as glaucoma ciliary syndrome,and 1 case as total uveitis in other hospitals.The misdiagnosis time ranged from 3 d to 5 years.After admission,based on detailed medical history inquiry combined with clinical data and related examinations,the patient was diagnosed as FUS,and received appropriate treatment.His vision recovered well and his condition was stable.Conclusion FUS is prone to misdiagnosis,and clinicians should strengthen their understanding and careful differential diagnosis to reduce or avoid misdiagnosis and mistreatment.