炎症性孔源性视网膜脱离:后葡萄膜炎中孔源性视网膜脱离的发生率和结局

A. Sultana
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引用次数: 1

摘要

背景:葡萄膜炎是我国各年龄组患者致盲的主要原因之一。我们已经报道了引起葡萄膜炎的各种原因。如果处理得当,所有的葡萄膜炎都不会导致失明。失明主要是由于这些患者的后遗症引起的并发症。失明可能是由于前段或后段受累。早期的表现和处理将有助于控制各种并发症。孔源性视网膜脱离是后葡萄膜炎患者的病因之一,它可因玻璃体和视网膜的改变而发生。葡萄膜炎可以是感染性的也可以是非感染性的。目的:探讨葡萄膜炎患者孔源性视网膜脱离的发生率、治疗及预后。材料与方法:所有到我们玻璃体视网膜科就诊的葡萄膜炎患者均接受详细检查,进行各种调查以了解病因,并根据临床表现进行处理。通过从旧病历中收集患者数据进行回顾性研究。研究时间为5年,从2014年6月至2019年6月。2014年6月至2019年6月至我科以后葡萄膜炎就诊的患者610例。所有患者均行BCVA、裂隙灯检查、IOP检查、眼底检查、b超扫描、OCT检查和文献检查。对所有病例进行全身检查,并进行实验室检查,如RBS、CBP、MANTOUX TEST、HIV和血清学检查(如果需要),对疑似病例进行风湿病检查。炎性孔源性视网膜脱离患者行屈曲加玻璃体切除及硅油内腔填塞。如果需要,对坏死区域和出现坏死或牵引性视网膜断裂时进行预防性激光治疗。结果:轻度PVR改变患者解剖预后良好,重度PVR改变患者解剖预后较差。几乎所有病例的视觉效果都很差。除油后所有病例BCVA均为CF½mt至CF 1mt,部分病例预后非常差,尽管解剖结果良好,但BCVA仅表现为光感。结论:炎症性视网膜脱离是葡萄膜炎患者非常严重的情况,PVR绝对是一个不良的预后因素,患者需要延长内膜填塞时间。葡萄膜炎病史持续时间较长的患者预后较差。即使早期的病例也显示不太有利的视觉结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Inflammatory Rhegmatogenous Retinal Detachment: Incidence and Outcome of Rhegmatogenous Retinal Detachments in Posterior Uveitis
BACKGROUND: Uveitis is one of the cause for blindness in our country in all age group of patients. Various causes of uveitis have been reported in our institute. All uveitis will not cause blindness, if appropriately managed. Blindness is mainly due to complications which occur as sequalae in these patients. Blindness can be due to anterior or posterior segment involvement. Early presentation and management will help in controlling the various complications. Rhegmatogenous retinal detachment is one of the cause in posterior uveitis patients which can occur due to changes in vitreous and retina. Uveitis can be infective or non-infective. AIM: Purpose of our study is to assess the incidence, management and outcome of rhegmatogenous retinal detachment in uveitis patients. MATERIALS AND METHODS: All patients of uveitis presented to our vitreo retina department were examined in detail, underwent various investigations to know the aetiology and managed based upon the clinical presentation. Retrospective study done by collecting patient data from old medical records. Duration of the study is 5 years, from June 2014 to June 2019. No of patients presented with posterior uveitis to our department during June 2014 to June 2019 were 610. All these patients underwent BCVA, Slit lamp examination, IOP, Fundus examination, b scan, OCT and documentation. Systemic examination done in all cases and also laboratory work up like RBS, CBP, MANTOUX TEST, HIV and serological testing if required, rheumatological work up in suspected cases. Patients with inflammatory rhegmatogenous retinal detachment underwent buckling plus pars plana vitrectomy and silicone oil endo tamponade. Fellow eye if required prophylactic laser done to the necrotic areas and when necrotic or tractional retinal breaks were present. RESULTS: Patients with mild PVR changes had good anatomical outcome, patients with severe PVR changes showed poor anatomical outcome. Visual outcome was poor in almost all cases. BCVA in all cases after oil removal was CF ½ mt to CF 1mt, some cases showed very poor outcome, BCVA in those cases was only perception of light in spite of good anatomical outcome. CONCLUSSION: Inflammatory retinal detachment is very serious condition in uveitis cases, PVR is definitely a poor prognostic factor, patient requires prolong endotamponade. Cases with prolong duration of uveitis history showed poor outcome. Even early presentation of cases also showed not much favourable visual outcome.
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