急性视网膜坏死综合征早期误诊原因分析

Analysis of the Causes of Misdiagnosis of Early Acute Retinal Necrosis Syn⁃drome

目的探讨急性视网膜坏死综合征的临床特点、诊治方法、误诊原因及防范措施。方法分析2024年6月误诊的急性视网膜坏死综合征1例的临床资料。结果本例患者因右眼视物模糊,视力下降10 d,伴眼红,眼前黑影遮挡感就诊,误诊为右眼虹膜睫状体炎,给予糖皮质激素治疗5 d,未见好转。后经眼底检查、房水眼内液检测,确诊为急性视网膜坏死综合征。误诊时间6 d。确诊后给予抗病毒、抗炎、抗凝和神经营养支持治疗,疾病控制好转出院。结论临床遇到表现为虹膜睫状体炎、玻璃体炎、中周视网膜散在黄白色圆片状坏死灶的患者,要仔细询问病史、散瞳检查眼底,条件允许时行房水眼内液检测,要考虑到急性视网膜坏死综合征的可能,以减少漏诊、误诊。

Objective To explore the clinical characteristics,diagnosis and treatment methods,causes of misdiagnosis and preventive measures of acute retinal necrosis syndrome(ARN).Methods The clinical data of 1 patient with ARN misdiagnosed in June 2024 were analyzed.Results The patient presented with blurred vision in the right eye,decreased vision for 10 d,accompanied by red eyes and a sense of shadow occlusion in front of the eyes.The patient was misdiagnosed with right iridocyclitis,and was treated with Glucocorticoid for 5 d,but no improvement was observed.After fundus examination and aqueous humor intraocular fluid detection,ARN was confirmed.The misdiagnosis lasted 6 d.After diagnosis,antiviral,anti-inflammatory,anticoagulant treatment and neuronutritional support were given.The disease was well controlled and the patient was discharged.Conclusion Patients presenting with iridocyclitis,vitreous inflammation,and scattered yellowish-white circular necrotic lesions of the central retina should be carefully inquired about the history,undergo mydriasis examination of the fundus,and intra-ocular fluid detection when conditions permit.The possibility of ARN should be considered to reduce missed diagnosis and misdiagnosis.