早期Vogt—小柳原田病的眼底特征和治疗分析(1)
【摘要】 目的：分析早期Vogt-小柳原田病(VKH)的临床特征和治疗预后。方法：回顾性分析2013年
7月-2015年4月本院收治的VKH患者27例作为研究对象，共54眼，进行常规视力、裂隙灯检查、间接眼底镜、眼底彩色照相、荧光素眼底血管造影(FFA)、光学相干断层扫描(OCT)等检查，并给予激素治疗，随访观察半年，总结分析眼底病变特征及治疗效果。结果：眼底表现为视乳头水肿、视网膜水肿、浆液性视网膜脱离；FFA表现为早期针尖样强荧光点，晚期视盘渗漏及视网膜多湖状荧光素积存。OCT表现为神经上皮层多发性脱离。激素治疗后患者视力均明显提高。结论：眼底表现、FFA、OCT等有助于早期VKH的诊断，早期系统规范化的激素治疗，可有效控制炎症，改善视力。
【关键词】 Vogt-小柳原田病； 眼底荧光血管造影； 光学相干断层扫描； 治疗
【Abstract】 Objective：To investigate the clinical characteristics and therapeutic outcomes of early Vogt-Koyanagi-Harada(VKH) disease.Method：27 patients(54 eyes) with VKH in our hospital from June 2013 to April 2015 were selected as the research objects.The examinations of visual acuity，slit lamp，indirect ophthalmoscopy，fundus color photography，fundus fluorescence angiography(FFA) and optical coherence tomography(OCT) were given to the patients.All patients were treated with corticosteroid.They were given follow-up for 6 months.The characteristics of fundus lesions and treatment effect were summarized and analyzed.Result：The fundus was characterized by papilledema，edema of retina and serous retinal detachment.FFA showed tip sample strong fluorescence at the early stage and optic disc leakage and multiple hyper-fluorescent pool in retina at the late stage.OCT showed multiple detachment of nerve epithelium.The visions of all patients were improved after hormonotherapy.Conclusion：The appearance of fundus，FFA and OCT are useful for the diagnosis of VKH.Early systemic and normalized hormonotherapy is effective for the control of inflammation and the improvement of vision.
, http://www.100md.com
【Key words】 Vogt-Koyanagi-Harada disease； Fundus fluorescence angiography； Optical coherence tomography； Treatment
First-author’s address：The Second People’s Hospital of Zhengzhou City，the Ophthalmic Hospital of Zhengzhou City，Zhengzhou 450006，China
doi：10.3969/j.issn.1674-4985.2015.35.041
Vogt-小柳原田病(Vogt-Koyanagi-Harada disease，VKH)是一种自身免疫性疾病，可累及全身多个系统，眼部主要表现为双侧肉芽肿性全葡萄膜炎[1]。国内发病率较高，约为所有葡萄膜炎的14%[2]。患者起病急，视力下降明显，大多数经早期系统治疗后预后好；但发病早期较易误诊和漏诊，从而贻误了最佳治疗时机，甚至导致盲目的发生，故该病早期的正确诊断及系统规范的治疗非常重要。因此，笔者总结分析了一组早期VKH患者的临床资料，探讨其眼底病变特征及治疗效果，现报告如下。
, 百拇医药
1 资料与方法
1.1 一般资料 回顾性分析2013年7月-2015年4月于本院眼科就诊，并经检查确诊为VKH的患者27例作为研究对象，共54眼，均为初次发病。诊断标准参照我国杨培增[3]提出的标准：(1)既往无眼外伤或内眼手术史；(2)双眼弥漫性脉络膜炎、脉络膜视网膜炎、视盘水肿、视网膜神经上皮层脱离、渗出性视网膜脱离；(3)FFA检查结果显示早期多灶性强荧光和晚期视网膜下多湖状荧光积存。排除标准：(1)近期应用糖皮质激素；(2)B超提示眼球壁增厚、眼球后间隙增宽等后巩膜炎表现。所选患者中男17例，女10例；年龄19～72岁，年龄中位数41岁，其中20～50岁21例(77.8%)。病程1～15 d，伴发头痛8例，耳鸣5例，有感冒样症状3例。主诉双眼视力下降22例，单眼视力下降5例；视力光感1例(2只眼)，<0.1的共16只眼，0.1～0.5的共28只眼，>0.5的共8只眼。眼前节检查均未见明显异常。, http://www.100md.com(邵玲 杜敏 闫淑)
7月-2015年4月本院收治的VKH患者27例作为研究对象，共54眼，进行常规视力、裂隙灯检查、间接眼底镜、眼底彩色照相、荧光素眼底血管造影(FFA)、光学相干断层扫描(OCT)等检查，并给予激素治疗，随访观察半年，总结分析眼底病变特征及治疗效果。结果：眼底表现为视乳头水肿、视网膜水肿、浆液性视网膜脱离；FFA表现为早期针尖样强荧光点，晚期视盘渗漏及视网膜多湖状荧光素积存。OCT表现为神经上皮层多发性脱离。激素治疗后患者视力均明显提高。结论：眼底表现、FFA、OCT等有助于早期VKH的诊断，早期系统规范化的激素治疗，可有效控制炎症，改善视力。
【关键词】 Vogt-小柳原田病； 眼底荧光血管造影； 光学相干断层扫描； 治疗
【Abstract】 Objective：To investigate the clinical characteristics and therapeutic outcomes of early Vogt-Koyanagi-Harada(VKH) disease.Method：27 patients(54 eyes) with VKH in our hospital from June 2013 to April 2015 were selected as the research objects.The examinations of visual acuity，slit lamp，indirect ophthalmoscopy，fundus color photography，fundus fluorescence angiography(FFA) and optical coherence tomography(OCT) were given to the patients.All patients were treated with corticosteroid.They were given follow-up for 6 months.The characteristics of fundus lesions and treatment effect were summarized and analyzed.Result：The fundus was characterized by papilledema，edema of retina and serous retinal detachment.FFA showed tip sample strong fluorescence at the early stage and optic disc leakage and multiple hyper-fluorescent pool in retina at the late stage.OCT showed multiple detachment of nerve epithelium.The visions of all patients were improved after hormonotherapy.Conclusion：The appearance of fundus，FFA and OCT are useful for the diagnosis of VKH.Early systemic and normalized hormonotherapy is effective for the control of inflammation and the improvement of vision.
, http://www.100md.com
【Key words】 Vogt-Koyanagi-Harada disease； Fundus fluorescence angiography； Optical coherence tomography； Treatment
First-author’s address：The Second People’s Hospital of Zhengzhou City，the Ophthalmic Hospital of Zhengzhou City，Zhengzhou 450006，China
doi：10.3969/j.issn.1674-4985.2015.35.041
Vogt-小柳原田病(Vogt-Koyanagi-Harada disease，VKH)是一种自身免疫性疾病，可累及全身多个系统，眼部主要表现为双侧肉芽肿性全葡萄膜炎[1]。国内发病率较高，约为所有葡萄膜炎的14%[2]。患者起病急，视力下降明显，大多数经早期系统治疗后预后好；但发病早期较易误诊和漏诊，从而贻误了最佳治疗时机，甚至导致盲目的发生，故该病早期的正确诊断及系统规范的治疗非常重要。因此，笔者总结分析了一组早期VKH患者的临床资料，探讨其眼底病变特征及治疗效果，现报告如下。
, 百拇医药
1 资料与方法
1.1 一般资料 回顾性分析2013年7月-2015年4月于本院眼科就诊，并经检查确诊为VKH的患者27例作为研究对象，共54眼，均为初次发病。诊断标准参照我国杨培增[3]提出的标准：(1)既往无眼外伤或内眼手术史；(2)双眼弥漫性脉络膜炎、脉络膜视网膜炎、视盘水肿、视网膜神经上皮层脱离、渗出性视网膜脱离；(3)FFA检查结果显示早期多灶性强荧光和晚期视网膜下多湖状荧光积存。排除标准：(1)近期应用糖皮质激素；(2)B超提示眼球壁增厚、眼球后间隙增宽等后巩膜炎表现。所选患者中男17例，女10例；年龄19～72岁，年龄中位数41岁，其中20～50岁21例(77.8%)。病程1～15 d，伴发头痛8例，耳鸣5例，有感冒样症状3例。主诉双眼视力下降22例，单眼视力下降5例；视力光感1例(2只眼)，<0.1的共16只眼，0.1～0.5的共28只眼，>0.5的共8只眼。眼前节检查均未见明显异常。, http://www.100md.com(邵玲 杜敏 闫淑)