糖皮质激素联合免疫抑制剂治疗非感染性后巩膜炎的短期疗效

doi:10.3760/cma.j.issn.1674-845X.2019.09.007

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摘要探讨糖皮质激素联合免疫抑制剂治疗非感染性后巩膜炎的短期疗效。方法：回顾性系列病例研究。收集2012年1月至2017年10月在温州医科大学附属第二医院眼科确诊为非感染性后巩膜炎的患者20例（20眼），治疗前和药物治疗后各时间点进行最佳矫正视力、眼压、眼底检查和辅助检查，应用B型超声分析患者球壁厚度，数据采用重复测量方差分析。结果：治疗前18眼存在眼痛，15眼视力下降，大部分患眼的视力在0.1～0.6之间；13眼存在前部巩膜炎症反应，17眼发生视盘水肿，18眼可见视网膜静脉血管扩张，9眼存在黄斑部脱离隆起，6眼存在渗出性视网膜脱离。治疗2 周后，18 眼疼痛症状明显缓解，7 眼视力得到提高。治疗1 个月后，前段炎症反应基本消退， 10眼视盘水肿和静脉血管扩张改善，黄斑部视网膜脱离均复位，视网膜/脉络膜皱褶明显好转。治疗3个月后，全部患者症状缓解。治疗6个月后，眼底异常改变基本消退；B超检查发现球壁厚度明显减轻，“T”征缓解，治疗前球壁厚度为（3.24±0.78）mm，而在治疗1周、2周，1、3、6个月后球壁厚度平均值分别为（2.82±0.63）mm，（2.01±0.68）mm，（1.86±0.44）mm、（1.68±0.45）mm、（1.43±0.65）mm，与治疗前比较，从第2周开始差异具有统计学意义（t=13.76，P=0.0017）。治疗2周后17例症状缓解，6例患者显效；治疗3个月后，所有患者症状得到缓解，9例显效，5例痊愈。结论：激素联合免疫抑制剂治疗可以有效地治疗后巩膜炎，改善症状，缓解体征，但是需长期治疗以预防复发。球壁厚度改变可以用来随访和评估疗效。

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关键词 ：巩膜, 后巩膜炎, 临床治疗, 葡萄膜炎

Abstract：To explore the short-term clinical outcome of treatment with corticosteroids and immunosuppressive drugs for non-infectious posterior scleritis. Methods: Twenty patients (20 eyes) who were diagnosed with posterior scleritis from January 2012 to October 2017 in the Department Ophthalmology of the Second Affiliated Hospital of Wenzhou Medical University were recruited for this retrospective series of case study. Clinical findings were documented before and after treatment for all patients. Patients also underwent testing for best corrected visual acuity, intraocular pressure, fundus examination, and posterior retinal examination with B-scan ultrasound. Examinations were performed at 1 week, 2 weeks, 1 month, 3 months and 6 months after the start of treatment. All results were quantitatively and statistically analyzed by variance analysis. Results: Before treatment, 18 patients (90%) had complained about pain and worsening vision, 13 patients had anterior uveitis and anterior scleritis, 17 eyes had optic disc swelling, and 18 eyes had retinal phlebectasia. After two weeks of treatment, 18 patients (90%) had relief from pain symptoms and 7 patients (35%) had improved visual acuity. Anterior inflammation eased in all patients after 1 month of treatment. Optic disc edema and retinal phlebectasia were alleviated in 10 eyes, the retinal/choroidal folds gradually resolved, and symptoms were eased in all cases after 3 months of treatment. Almost all abnormalities in the fundus disappeared after 6 months of treatment. After treatment, B-scan ultrasound examination showed that eyeball thickness was reduced and accompanied by "T" syndrome remission, with an average of 2.82±0.63 mm, 2.01±0.68 mm, 1.86±0.44 mm, 1.68±0.45 mm, and 1.43±0.65 mm after treatment for 1 week, 2 weeks, 1 month, 3 months and 6 months, respectively, compared to 3.24±0.78 mm before treatment. Compared to pre-treatment, the difference from 2 weeks after treatment was statistically significant (t=13.76, P=0.0017). Symptoms were alleviated in about 17 cases after two weeks of treatment with an effective rate of 30% (6 cases). Effectiveness was at 45% (9 cases) after 3 months of treatment, and 5 patients (25%) were cured. Conclusions: Aggressive therapy with systemic corticosteroids and immunosuppressive agents to treat posterior scleritis always achieves good resolution in a short period of time with a favorable visual outcome but long-term therapy is often required to prevent recurrence. B-scan ultrasound is the most useful option for assessing the therapeutic effect during follow-up.

Key words： sclera posterior scleritis clinical treatment uveitis

收稿日期: 2018-03-24

基金资助:温州市基础性科研计划项目（Y20190167）

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

引用本文:

董志章1 甘一峰1 郑海华1 李梅2. 糖皮质激素联合免疫抑制剂治疗非感染性后巩膜炎的短期疗效[J]. 中华眼视光学与视觉科学杂志, 2019, 21(9): 682-687. Zhizhang Dong1,Yifeng Gan1,Haihua Zheng1,Mei Li2. The Short-Term Outcome of Treatment with Corticosteroids and Immunosuppressive Drugs for Non-Infectious Posterior Scleritis. Chinese Journal of Optometry Ophthalmology and Visual science, 2019, 21(9): 682-687. DOI: 10.3760/cma.j.issn.1674-845X.2019.09.007

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https://www.cjoovs.com/CN/ 10.3760/cma.j.issn.1674-845X.2019.09.007 或 https://www.cjoovs.com/CN/Y2019/V21/I9/682

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