中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2013年
4期
384-387
,共4页
万莉%李世迎%余涛%刘勇%黎海涛%阴正勤
萬莉%李世迎%餘濤%劉勇%黎海濤%陰正勤
만리%리세영%여도%류용%려해도%음정근
巩膜炎/诊断%巩膜炎/治疗%疾病特征%超声检查%磁共振成像
鞏膜炎/診斷%鞏膜炎/治療%疾病特徵%超聲檢查%磁共振成像
공막염/진단%공막염/치료%질병특정%초성검사%자공진성상
Scleritis/diagnosis%Scleritis/therapy%Disease attributes%Ultrasonography%Magnetic resonance imaging
目的 观察后巩膜炎患者临床特征.方法 临床检查确诊的后巩膜炎患者10例16只眼纳入研究.患者中,男性7例,女性3例;年龄18～75岁,平均年龄(42.0±14.7)岁.其中,18、75岁分别为1例;33～55岁8例.所有患者常规行视力、裂隙灯显微镜和前置镜、B型超声、眼底彩色照相、荧光素眼底血管造影(FFA)、胸部X线片检查,行眼部MRI检查11只眼.依据B型超声检查结果,将后巩膜炎分为弥漫型和结节型.其中,弥漫型8例14只眼,结节型2例2只眼.患眼视力光感～0.4.实验室相关检查结果均为阴性.弥漫型患者接受全身和(或)眼局部糖皮质激素治疗.结节型患者初诊时脉络膜黑色素瘤不能除外,在外院自行要求行眼球摘除手术.结果 弥漫型14只眼中,球结膜充血水肿8只眼;眼睑肿胀2只眼;未见眼部阳性体征4只眼.结节型2只眼均未见球结膜充血水肿或眼睑肿胀.FFA检查结果显示,眼底后极部早期可见点状强荧光,晚期荧光渗漏11只眼;病灶周围视网膜广泛强弱荧光交织2只眼;未见异常3只眼.眼B超检查结果显示,弥漫型14只眼中,后巩膜弥漫性增厚＞2 mm者10只眼,可见典型“T”形征.表现不典型4只眼.结节型2只眼均表现为脉络膜结节型回声增强,中等内反射,血流丰富.MRI检查结果显示,后极部眼球壁呈弥漫型增厚9只眼;结节型占位2只眼,后极部眼球壁呈结节型增厚.所有病变均表现为T1WI低信号,T2WI高信号.接受治疗的6例弥漫型后巩膜炎患者,治疗后增厚的后巩膜恢复正常厚度.结节型2只眼外院行眼球摘除,病理诊断分别为肉芽肿性后巩膜炎和坏死性后巩膜炎.16只眼中,误诊为慢性闭角型青光眼2只眼;急性虹膜睫状体炎1只眼;脉络膜黑色素瘤2只眼;中心性浆液性脉络膜视网膜病变2只眼;球后视神经炎2只眼.结论 后巩膜炎好发于中青年患者.弥漫型患者多伴有结膜充血水肿或眼睑肿胀等眼前节体征;结节型患者眼前节多正常.眼B型超声和MRI检查可见典型图像特征.全身和(或)眼局部糖皮质激素治疗可有效缓解患者症状.
目的 觀察後鞏膜炎患者臨床特徵.方法 臨床檢查確診的後鞏膜炎患者10例16隻眼納入研究.患者中,男性7例,女性3例;年齡18～75歲,平均年齡(42.0±14.7)歲.其中,18、75歲分彆為1例;33～55歲8例.所有患者常規行視力、裂隙燈顯微鏡和前置鏡、B型超聲、眼底綵色照相、熒光素眼底血管造影(FFA)、胸部X線片檢查,行眼部MRI檢查11隻眼.依據B型超聲檢查結果,將後鞏膜炎分為瀰漫型和結節型.其中,瀰漫型8例14隻眼,結節型2例2隻眼.患眼視力光感～0.4.實驗室相關檢查結果均為陰性.瀰漫型患者接受全身和(或)眼跼部糖皮質激素治療.結節型患者初診時脈絡膜黑色素瘤不能除外,在外院自行要求行眼毬摘除手術.結果 瀰漫型14隻眼中,毬結膜充血水腫8隻眼;眼瞼腫脹2隻眼;未見眼部暘性體徵4隻眼.結節型2隻眼均未見毬結膜充血水腫或眼瞼腫脹.FFA檢查結果顯示,眼底後極部早期可見點狀彊熒光,晚期熒光滲漏11隻眼;病竈週圍視網膜廣汎彊弱熒光交織2隻眼;未見異常3隻眼.眼B超檢查結果顯示,瀰漫型14隻眼中,後鞏膜瀰漫性增厚＞2 mm者10隻眼,可見典型“T”形徵.錶現不典型4隻眼.結節型2隻眼均錶現為脈絡膜結節型迴聲增彊,中等內反射,血流豐富.MRI檢查結果顯示,後極部眼毬壁呈瀰漫型增厚9隻眼;結節型佔位2隻眼,後極部眼毬壁呈結節型增厚.所有病變均錶現為T1WI低信號,T2WI高信號.接受治療的6例瀰漫型後鞏膜炎患者,治療後增厚的後鞏膜恢複正常厚度.結節型2隻眼外院行眼毬摘除,病理診斷分彆為肉芽腫性後鞏膜炎和壞死性後鞏膜炎.16隻眼中,誤診為慢性閉角型青光眼2隻眼;急性虹膜睫狀體炎1隻眼;脈絡膜黑色素瘤2隻眼;中心性漿液性脈絡膜視網膜病變2隻眼;毬後視神經炎2隻眼.結論 後鞏膜炎好髮于中青年患者.瀰漫型患者多伴有結膜充血水腫或眼瞼腫脹等眼前節體徵;結節型患者眼前節多正常.眼B型超聲和MRI檢查可見典型圖像特徵.全身和(或)眼跼部糖皮質激素治療可有效緩解患者癥狀.
목적 관찰후공막염환자림상특정.방법 림상검사학진적후공막염환자10례16지안납입연구.환자중,남성7례,녀성3례;년령18～75세,평균년령(42.0±14.7)세.기중,18、75세분별위1례;33～55세8례.소유환자상규행시력、렬극등현미경화전치경、B형초성、안저채색조상、형광소안저혈관조영(FFA)、흉부X선편검사,행안부MRI검사11지안.의거B형초성검사결과,장후공막염분위미만형화결절형.기중,미만형8례14지안,결절형2례2지안.환안시력광감～0.4.실험실상관검사결과균위음성.미만형환자접수전신화(혹)안국부당피질격소치료.결절형환자초진시맥락막흑색소류불능제외,재외원자행요구행안구적제수술.결과 미만형14지안중,구결막충혈수종8지안;안검종창2지안;미견안부양성체정4지안.결절형2지안균미견구결막충혈수종혹안검종창.FFA검사결과현시,안저후겁부조기가견점상강형광,만기형광삼루11지안;병조주위시망막엄범강약형광교직2지안;미견이상3지안.안B초검사결과현시,미만형14지안중,후공막미만성증후＞2 mm자10지안,가견전형“T”형정.표현불전형4지안.결절형2지안균표현위맥락막결절형회성증강,중등내반사,혈류봉부.MRI검사결과현시,후겁부안구벽정미만형증후9지안;결절형점위2지안,후겁부안구벽정결절형증후.소유병변균표현위T1WI저신호,T2WI고신호.접수치료적6례미만형후공막염환자,치료후증후적후공막회복정상후도.결절형2지안외원행안구적제,병리진단분별위육아종성후공막염화배사성후공막염.16지안중,오진위만성폐각형청광안2지안;급성홍막첩상체염1지안;맥락막흑색소류2지안;중심성장액성맥락막시망막병변2지안;구후시신경염2지안.결론 후공막염호발우중청년환자.미만형환자다반유결막충혈수종혹안검종창등안전절체정;결절형환자안전절다정상.안B형초성화MRI검사가견전형도상특정.전신화(혹)안국부당피질격소치료가유효완해환자증상.
Objectives To observe the clinical characteristics of patients with posterior scleritis.Methods Ten patients with 16 eyes diagnosed as posterior scleritis were enrolled in this study.Ten patients consisted of seven males and three females.Their age ranged from 18 to 75 years old,with a mean age of 42.0±14.7 years old.Except for two patients aged 18 and 75 years old,the other eight patients aged 33 to 55 years old.Routine eye examination was performed including visual acuity,slit lamp microscope,ophthalmoscope,B scan ultrasound,color fundus photography,fundus fluorescein angiography (FFA),orbit MRI and chest X-ray.According to the B scan ultrasonic examination,these ten posterior scleritis cases were divided into diffused and nodular types.Among them,the diffused type had 8 cases (14 eyes),the nodular type had 2 cases (2 eyes).The visual acuities of ten patients were from light perception to 0.4.The blood laboratory tests were negative in all cases.The diffused posterior scleritis patients received systemic and (or) local glucocorticoid therapy.The nodular posterior scleritis patients could not be ruled out choroidal melanoma in the initial evaluation,and they underwent enucleation operation in other hospitals.Results In the 14 eyes of diffused posterior scleritis,conjunctival congestion and edema were observed in 8eyes,eyelid edema in 2 eyes,normal eye surface in 4 eyes.In the two eyes of nodular posterior scleritis,there was no conjunctival congestion and edema or eyelids swelling.All 16 eyes performed FFA,11 eyes had fundus posterior pole early dot-like hyperfluorescence followed by leakage of fluorescence in the late stage,two eyes had hyperfluorescence mixed with hypofluorescence in the nearby retina of the lesion,and the rest three eyes had no abnormality in FFA.In 14 eyes of diffused type posterior scleritis,B scan ultrasound showed diffused scleral thickening more than 2 mm in 10 eyes with a typical "T" shape sign.The other 4eyes did not show typical sign in ultrasound.In 2 eyes of nodular type,ultrasound showed nodular enhanced echo in choroid with medium internal reflection and abundant blood flow.Eleven eyes underwent orbit MRI scan,9 eyes displayed diffused posterior sclera thickening,2 eyes showed nodular lesions in choroid.All lesions showed low signal on T1WI,high signal on T2WI.After treatment,six diffused posterior scleritis patients recovered to normal scleral thickness.Two nodular posterior scleritis patients underwent enucleation showed granulomatous posterior scleritis and necrotic posterior scleritis in pathology.Overall,16 eyes of 10 patients were misdiagnosed as chronic angl~closure glaucoma in 2 eyes,acute iridocyclitis in 1 eye,central serous chorioretinopathy in 2 eyes,retrobulbar neuritis in 2 eyes,and choroidal melanoma in 2eyes.Conclusions Posterior scleritis occurs mostly in young patients.The diffused posterior scleritis patients usually has anterior segment signs including conjunctival congestion and edema or eyelids swelling,while the nodular posterior scleritis patients has normal anterior segment signs.B scan ultrasonic and MRI examination showed typical image features.Systemic and (or) local glucocorticoid therapy can effectively release the symptoms of these patients.
