急性视网膜坏死综合征的临床特征及预后

Clinical features and prognosis of acute retinal necrosis syndrome

目的观察急性视网膜坏死综合征(ARNS)的临床特征及预后。方法回顾性病例系列研究。纳入郑州大学第一附属医院2016年1月至2022年3月ARNS者27例(32眼)。所有患者均接受全身及局部规范化的抗病毒抗炎治疗,治疗后随访3个月,观察治疗后视力、眼底情况、眼底荧光素血管造影及光学相干断层扫描成像检查的临床特征。结果末次随访视力(BCVA)提高7眼(21.83%),不变5眼(15.63%),下降20眼(62.50%)。典型的视网膜表现有:不同程度的玻璃体浑浊29眼(90.63%),视网膜血管炎27眼(84.38%),典型的周边视网膜黄白色坏死灶29眼(90.63%),坏死灶累及范围3个钟点位至全周(10.48±2.50),呈逐渐融合向后极部发展的趋势。不典型的视网膜表现有:视盘出血、周边点片状坏死伴孤立黄斑区坏死灶1眼(3.13%),早期出现视网膜周边黄白色点状病灶1眼(3.13%),未观察到黄白色坏死灶者2眼(6.25%)。在随访过程中,视网膜脱离19眼(59.38%);双眼发病患者中,先发眼视网膜脱离4眼(80.00%),后发眼视网膜脱离1眼(20.00%),接受玻璃体切除手术19眼(59.38%)。末次随访视网膜在位者30眼(93.75%),双眼发病患者视网膜均在位。结论典型的ARNS有周边大片视网膜坏死灶;双眼ARNS后发眼的视网膜受累范围、视网膜脱离率均小于先发眼,视力预后优于先发眼。

Objective To observe the clinical features and prognosis of acute retinal necrosis syndrome(ARNS).Methods This was a retrospective case series study.A total of 32 eyes of 27 cases with ARNS from Jan.2016 to Mar.2022 in the First Affiliated Hospital of Zhengzhou University were included.All patients treated with systemic and local standardized antiviral and anti-inflammatory therapy.The follow-up time was 3 months after treatment.The clinical features of visual acuity,fundus condition,fundus fluorescein angiography and optical coherence tomography were observed during the initial diagnosis.Results Compared to the initial BCVA,the final BCVA showed that visual acuity improved in 7 eyes(21.83%),remained the same in 5 eyes(15.63%),and decreased in 20 eyes(62.50%).Typical retinal manifestations included varying degrees of vitreous opacities in 29 eyes(90.63%),retinal vasculitis in 27 eyes(84.38%),typical peripheral retinal yellow-white necrotic foci with a cumulative range of 3 to 12(10.48±2.50)clock spots,and with a tendency of gradual fusion toward the posterior pole in 29 eyes(90.63%).Atypical retinal manifestations were optic disc hemorrhage and peripheral punctate necrosis with isolated macular area necrotic foci in 1 eye(3.13%),early yellow-white peripheral retinal punctate lesions in 1 eye(3.13%),and no yellow-white necrotic foci were observed in 2 eyes(6.25%).During the final follow-up,19 eyes(59.38%)had retinal detachment.The rate of retinal detachment was 80%(4 eyes),which was higher in the first eye than the 20.00%(1 eye)in the second eye in binocular ARNS.Nineteen eyes(59.38%)underwent pars plana vitrectomy.The retina of 30 eyes(93.75%)and all binocular cases were in situ at the final follow-up.Conclusion The typical patient with ARNS has large foci of peripheral retinal necrosis;the extent of retinal involvement and the rate of retinal detachment in the second eye with bilateral ARNS are less than that in the first eye,and the prognosis for best-corrected visual acuity is better than that in the first eye.