30例非感染性后巩膜炎临床特征分析

doi:10.3760/cma.j.issn.1674-845X.2018.11.009.

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摘要目的总结非感染性后巩膜炎的临床特征,以期为临床上准确诊断、合理治疗提供依据。方法回顾性系列病例研究。收集2007年1月至2016年10月在中山大学中山眼科中心和温州医科大学附属第二医院就诊,经各项检查确诊为非感染性后巩膜炎的患者30例（40眼）,年龄（35.2±14.3）岁。所有病例都进行既往史回顾和病史分析,收集入选病例相关临床资料,包括最佳矫正视力（BCVA）、眼压、眼部常规检查和辅助检查等,并进行临床分析。结果10例双眼发病,33眼（83%）以眼痛伴视力下降为主诉就诊。就诊时10眼（25%）视力下降到0.1以下,13眼（32%）视力在0.1~0.6之间,17眼（43%）视力在0.6~1.2之间。眼压为（13.2±4.4）mmHg。在眼前段,22眼（55%）伴发前段巩膜炎,18眼（45%）有前葡萄膜炎症状;在眼后段,22眼（55%）发生视盘水肿,21眼（53%）存在视网膜静脉扩张,13眼（33%）黄斑部隆起脱离。另外发现渗出性视网膜脱离7眼（18%）,黄斑部星芒样渗出3眼（8%）,脉络膜脱离3眼（8%）,视网膜/脉络膜皱褶2眼（5%）,视网膜中央静脉阻塞3眼（8%）。所有患者眼部B超检查发现球壁弥漫性增厚,眼球壁后可见环形低回声,共同形成典型的"T"形征,球壁厚度为（2.21±0.85）mm。结论非感染性后巩膜炎临床表现多样,眼底可以有视盘水肿、静脉扩张、黄斑部渗出、黄斑部脱离隆起等体征,B超检查是后巩膜炎最特异性检查方法,可用于明确诊断。

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关键词 ：巩膜, 巩膜炎, 葡萄膜炎, 临床特征

Abstract：Objective:Summarize the clinical features in posterior scleritis, to provide the basis for correct diagnosis and rational treatment in clinic. Methods:Retrospective interventional case series study. This study included 30 patients (40 eyes), average ± standard deviation age 35.2 ± 14.3 years, who were diagnosed from January 2007 to October 2016 at the Second Affiliated Hospital of Wenzhou Medical University and Zhongshan Ophthalmic Center of Sun Yat-sen University with non-infectious posterior scleritis. The medical history of all cases was documented, and the clinical features were recorded. The examinations included best corrected visual acuity, slit lamp examination, intraocular pressure, B-scan ultrasonography, and other routine eye and auxiliary examinations. Results:Posterior scleritis was unilateral in 20 cases and bilateral in 10 cases at presentation. Thirty-three eyes (83%) were painful and accompanied by vision loss. The visual acuity of 10 eyes (25%) was below 0.1, 13 eyes (32%) were between 0.1 and 0.6, and 17 eyes (43%) were between 0.6 and 1.2. The mean intraocular pressure was 13.2 ± 4.4 mmHg. Eighteen eyes (45%) had anterior uveitis, and 22 eyes (55%) had anterior scleritis. In the posterior segment, 22 eyes (55%) had optic disc swelling, 21 eyes (53%) had retinal phlebectasia, and 13 eyes (33%) had macular exudation detachment. Seven eyes (18%) had exudative retinal detachment, 3 eyes (8%) had macular stellate exudation, 3 eyes (8%) had choroidal detachment, 3 eyes (8%) had central retinal vein occlusion, and 2 eyes (5%) had a retinal or choroidal striae. B-scan ultrasound found increased thickness of the eyeball, with an average of 2.21 ± 0.85 mm. The posterior chamber had an annular hypoechoic with a typical T-sign. Conclusions:Non-infectious posterior scleritis exhibited some features in common with concurrent of anterior uveitis, disc swelling, retinal phlebectasia, macular exudation detachment, and retinal striae. B-scan ultrasound was the most useful diagnostic resource to confirm non-infectious posterior scleritis, with cases having the typical T-sign.

Key words： sclera scleritis uveitis clinical features

收稿日期: 2017-10-18

基金资助:温州市公益性科技计划项目（Y20150080）

通讯作者: 李梅（ORCID：0000-0002-4024-0987）,Email：oculistli@163.com

作者简介: 董志章（ORCID：0000-0001-5150-8750）,Email：416898460@qq.com

引用本文:

董志章, 甘一峰, 郑海华, 李梅. 30例非感染性后巩膜炎临床特征分析[J]. 中华眼视光学与视觉科学杂志, 2018, 20(11): 688-693. Zhizhang Dong, Yifeng Gan, Haihua Zheng, Mei Li. Non-Infectious Posterior Scleritis: Clinical Analysis in a Series of 30 Patients. Chinese Journal of Optometry Ophthalmology and Visual science, 2018, 20(11): 688-693.

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