梅毒性脉络膜视网膜炎患者114例的临床特征分析

Clinical characteristics analysis of 114 patients with syphilitic chorioretinitis

目的:探讨梅毒性脉络膜视网膜炎的发病年龄、性别、职业、婚姻特征、临床症状、体征、眼底造影特征和激光扫描眼底检查特点。方法:回顾性病例系列研究。收集2006-01/2023-01确诊的梅毒性脉络膜视网膜炎患者114例138眼(其中24例为双眼)纳入本研究。所有患者行最佳矫正视力、眼压、眼底照相、光学相干断层扫描(OCT)、荧光素眼底血管造影(FFA)、吲哚菁绿造影(ICGA)、视野、视觉电生理检查;血化验包括快速血浆反应素环状卡片试验(RPR)及梅毒螺旋体血凝试验(TPPA)、结核菌素试验、结核斑点试验、人类免疫缺陷病毒、人白细胞抗原B27、风湿系列检查资料。结果:所有患者RPR及TPPA阳性,其他化验检查阴性,确诊梅毒性脉络膜视网膜炎。平均发病年龄44±13.1岁,男59例(51.8%),女55例(48.2%),单眼90例(78.9%),双眼24例(21.1%),其性别、婚姻以及职业无显著特征。临床主要表现为视力降低、视盘充血以及后极部视网膜灰黄色混浊;FFA特征主要表现为早期黄斑周围点样弱背景荧光、视网膜血管荧光渗漏染色、视网膜RPE荧光积存以及视盘染色或强荧光;ICGA以及OCT特征主要表现为晚期后极部鳞状弱荧光,FFA与ICGA之间的关系对称一致,OCT显示玻璃体高反射点以及视网膜色素上皮针尖样凸起。结论:梅毒性脉络膜视网膜炎患者发病年龄平均44岁,单眼发病多见,患者性别、婚姻、职业无显著特征,临床主要表现为视力降低,玻璃体灰白色细胞,后极部视网膜混浊增厚感、灰黄色改变,正确识别OCT、FFA、ICGA特征可以减少漏诊误诊,早期正确诊治患者。

AIM:To investigate the onset of age,gender,profession,marital characteristics,clinical symptoms,signs,image characteristics of fundus and laser scanning features of syphilitic chorioretinitis.METHODS:Retrospective case series study.A total of 114 patients(138 eyes),24 of whom were double eyes diagnosed with syphilitic chorioretinitis from January 2006 to January 2023 were included in this study.All of the data were collected from eye examination including the best corrected visual acuity(BCVA),intraocular pressure(IOP),fundus photography,optical coherence tomography(OCT),fundus fluorescein angiography(FFA),indocyanine green angiography(ICGA),visual field,visual evoked response;and blood tests including rapid plasma reagin(RPR)test and treponema pallidum hemagglutination(TPPA)test,tuberculin test,tuberculosis spot test,human immunodeficiency virus,human leukocyte antigen-B27,rheumatism series examination.RESULTS:All patients tested positive for RPR and TPPA,while other laboratory tests were negative,confirming the diagnosis of syphilitic chorioretinopathy.The average age of onset was 44±13.1 years old,with 59 males(51.8%),55 females(48.2%),90 monocular cases(78.9%),and 24 binocular cases(21.1%),and there were no significant differences in gender,marriage,or occupation.The main clinical features were visual loss,hyperemia of the optic disc,grayish-yellow opacity of the central retina;FFA mainly showed early dot weak background fluorescence in the peripheral region of the macula,retinal blood vessel fluorescence leakage staining,retinal pigment epithelium(RPE)fluorescence accumulation and optic disc staining or strong fluorescence;ICGA and OCT were mainly manifested by squamous weak fluorescence of the posterior retina;and the manifestations of FFA and ICGA were symmetrical;OCT revealed hyperreflective dots and pinpoint projection of RPE.CONCLUSION:The median age of onset in patients with syphilitic chorioretinitis is 44 years old,and monocular onset is more common.The patient’s gender,marriage,and occupation have no significant characteristics.The clinical manifestations mainly include decreased vision,gray white cells in the vitreous body,thickening of the posterior pole retina,and grayish yellow changes.Correctly identifying OCT,FFA,and ICGA features can reduce missed diagnosis and misdiagnosis,and make an early and correct diagnosis and treatment of patients.