中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2014年
5期
477-479
,共3页
赵慧英%陈冬军%陈建华%王伟%吴香丽%刘彦%殷英霞
趙慧英%陳鼕軍%陳建華%王偉%吳香麗%劉彥%慇英霞
조혜영%진동군%진건화%왕위%오향려%류언%은영하
结核,眼/诊断%结核,肺/并发症
結覈,眼/診斷%結覈,肺/併髮癥
결핵,안/진단%결핵,폐/병발증
Tuberculosis,ocular/diagnosis%Tuberculosis,pulmonary/complications
目的 观察肺结核合并拟诊眼内结核患者的眼部表现特征.方法 对临床确诊为活动性肺结核的159例患者行视力、裂隙灯显微镜及间接检眼镜等全面眼科检查,对眼底可见视网膜脉络膜炎性浸润灶、视网膜出血、视网膜脱离等可疑病灶者同时行荧光素眼底血管造影(FFA)及光相干断层扫描(OCT)检查,判定其是否合并拟诊眼内结核.159例患者中,9例16只眼拟诊眼内结核,拟诊眼内结核检出率为5.67％.其中,男性5例,女性4例;年龄19～64岁,平均年龄35.12岁.双眼发病7例,单眼发病2例.葡萄膜炎8例15只眼,占患眼的93.75％;视网膜中央静脉阻塞(CRVO)1例1只眼,占患眼的6.25％.所有拟诊眼内结核患者血清快速梅毒螺旋体血凝试验、人类免疫缺陷病毒抗体检测均为阴性;弓形虫抗体滴度正常范围;CRVO患者血脂、血糖、血液流变检查未见异常.观察拟诊眼内结核患眼的眼部表现特征.结果 16只拟诊眼内结核眼中,矫正视力为光感～0.15者6只眼,均为全葡萄膜炎者;矫正视力为0.8～1.0者10只眼.眼前节改变10只眼,其中肉芽肿性葡萄膜炎8只眼,非肉芽肿性葡萄膜炎2只眼.肉芽肿性葡萄膜炎患眼表现为虹膜结节、虹膜后粘连及羊脂状角膜后沉着(KP);非肉芽肿性葡萄膜炎患眼表现为KP、无虹膜结节和虹膜后粘连.脉络膜结节7只眼,其眼底可见3～7个1/4～1/2视盘直径大小不等、灰白色且边界不清楚的病灶,伴局部视网膜浅脱离;FFA检查表现为动脉期、动静脉期病灶呈边界不清楚的弱荧光区,后期病灶区荧光逐渐增强,晚期病灶呈边界不清楚的强荧光、荧光素积存;OCT检查可见病灶处视网膜色素上皮液性隆起.CRVO1只眼,眼底表现为点、片、线状出血,部分出血灶中心可见白色病灶.结论 拟诊眼内结核患眼主要表现为眼前节肉芽肿性炎症改变和多发性脉络膜结节,也可单纯表现为CRVO.
目的 觀察肺結覈閤併擬診眼內結覈患者的眼部錶現特徵.方法 對臨床確診為活動性肺結覈的159例患者行視力、裂隙燈顯微鏡及間接檢眼鏡等全麵眼科檢查,對眼底可見視網膜脈絡膜炎性浸潤竈、視網膜齣血、視網膜脫離等可疑病竈者同時行熒光素眼底血管造影(FFA)及光相榦斷層掃描(OCT)檢查,判定其是否閤併擬診眼內結覈.159例患者中,9例16隻眼擬診眼內結覈,擬診眼內結覈檢齣率為5.67％.其中,男性5例,女性4例;年齡19～64歲,平均年齡35.12歲.雙眼髮病7例,單眼髮病2例.葡萄膜炎8例15隻眼,佔患眼的93.75％;視網膜中央靜脈阻塞(CRVO)1例1隻眼,佔患眼的6.25％.所有擬診眼內結覈患者血清快速梅毒螺鏇體血凝試驗、人類免疫缺陷病毒抗體檢測均為陰性;弓形蟲抗體滴度正常範圍;CRVO患者血脂、血糖、血液流變檢查未見異常.觀察擬診眼內結覈患眼的眼部錶現特徵.結果 16隻擬診眼內結覈眼中,矯正視力為光感～0.15者6隻眼,均為全葡萄膜炎者;矯正視力為0.8～1.0者10隻眼.眼前節改變10隻眼,其中肉芽腫性葡萄膜炎8隻眼,非肉芽腫性葡萄膜炎2隻眼.肉芽腫性葡萄膜炎患眼錶現為虹膜結節、虹膜後粘連及羊脂狀角膜後沉著(KP);非肉芽腫性葡萄膜炎患眼錶現為KP、無虹膜結節和虹膜後粘連.脈絡膜結節7隻眼,其眼底可見3～7箇1/4～1/2視盤直徑大小不等、灰白色且邊界不清楚的病竈,伴跼部視網膜淺脫離;FFA檢查錶現為動脈期、動靜脈期病竈呈邊界不清楚的弱熒光區,後期病竈區熒光逐漸增彊,晚期病竈呈邊界不清楚的彊熒光、熒光素積存;OCT檢查可見病竈處視網膜色素上皮液性隆起.CRVO1隻眼,眼底錶現為點、片、線狀齣血,部分齣血竈中心可見白色病竈.結論 擬診眼內結覈患眼主要錶現為眼前節肉芽腫性炎癥改變和多髮性脈絡膜結節,也可單純錶現為CRVO.
목적 관찰폐결핵합병의진안내결핵환자적안부표현특정.방법 대림상학진위활동성폐결핵적159례환자행시력、렬극등현미경급간접검안경등전면안과검사,대안저가견시망막맥락막염성침윤조、시망막출혈、시망막탈리등가의병조자동시행형광소안저혈관조영(FFA)급광상간단층소묘(OCT)검사,판정기시부합병의진안내결핵.159례환자중,9례16지안의진안내결핵,의진안내결핵검출솔위5.67％.기중,남성5례,녀성4례;년령19～64세,평균년령35.12세.쌍안발병7례,단안발병2례.포도막염8례15지안,점환안적93.75％;시망막중앙정맥조새(CRVO)1례1지안,점환안적6.25％.소유의진안내결핵환자혈청쾌속매독라선체혈응시험、인류면역결함병독항체검측균위음성;궁형충항체적도정상범위;CRVO환자혈지、혈당、혈액류변검사미견이상.관찰의진안내결핵환안적안부표현특정.결과 16지의진안내결핵안중,교정시력위광감～0.15자6지안,균위전포도막염자;교정시력위0.8～1.0자10지안.안전절개변10지안,기중육아종성포도막염8지안,비육아종성포도막염2지안.육아종성포도막염환안표현위홍막결절、홍막후점련급양지상각막후침착(KP);비육아종성포도막염환안표현위KP、무홍막결절화홍막후점련.맥락막결절7지안,기안저가견3～7개1/4～1/2시반직경대소불등、회백색차변계불청초적병조,반국부시망막천탈리;FFA검사표현위동맥기、동정맥기병조정변계불청초적약형광구,후기병조구형광축점증강,만기병조정변계불청초적강형광、형광소적존;OCT검사가견병조처시망막색소상피액성륭기.CRVO1지안,안저표현위점、편、선상출혈,부분출혈조중심가견백색병조.결론 의진안내결핵환안주요표현위안전절육아종성염증개변화다발성맥락막결절,야가단순표현위CRVO.
Objective To observe the ocular manifestations of presumed ocular tuberculosis in patients with pulmonary tuberculosis.Methods One hundred and fifty nine patients with pulmonary tuberculosis received examinations of visual acuity,slit lamp microscopy and indirect ophthalmoscopy.Those patients with retinochoroidal inflammatory lesions,retinal hemorrhages or detachments underwent fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) to determine whether the presumed ocular tuberculosis was involved.There were 9 patients (16 eyes,5.67％) of presumed ocular tuberculosis,including 5 males and 4 females.The age was ranged from 19 to 64 years old,with an average of 35.12 years.Seven patients were affected bilaterally and 2 patients affected unilaterally.There were 8 patients (15eyes,93.75％) with uveitis and 1 patient (1 eye,6.25％) with central retinal vein occlusion (CRVO).The blood laboratory tests were negative in all cases.Results The corrected vision was from light sensation to 0.15 in 6 uveitis eyes,0.8 to 1.0 in 10 eyes.The anterior segment change was found in 10 eyes,which including granulomatous uveitis (8 eyes) and non-granulomatous uveitis (2 eyes).Granulomatous uveitis eyes had iris nodules,posterior synechia of the iris and mutton-fat keratic precipitates (KP).Nongranulomatous uveitis eyes had KP only.Choroidal tubercles were found in 7 eyes in which 3-7 off-white lesions of varying sizes were found with local retinal detachment.FFA revealed hypo-fluorescence with obscure boundary in arterial phase and arterial and venous phase,and hyper-fluorescence with obscure boundary in later phase.OCT showed retinal pigment epithelium uplift.There was 1 eye with CRVO,which had punctate,splinter and linear hemorrhage,white lesions in some hemorrhagic focus.Conclusion The presumed ocular tuberculosis eyes showed mainly granulomatous inflammation and multiple choroid tubercles,and CRVO sometime.
