摘要
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〉2mm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T1WT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。
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 ）（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 glucoeorticoid therapy. The nodular posterior scleritis patients could not be ruled out choroidal melanoma in the initial evaluation, and they underwent enueleation operation in other hospitals. Results In the 14 eyes of diffused posterior scleritis, conjunctival congestion and edema were observed in 8 eyes, 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 t6 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 TlWI, high signal on T2WI. After treatment, six diffused posterior seleritis 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 angle-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 2 eyes. Conclusions Posterior scleritis occurs mostly in young patients. The diffused posterior scleritis patients usually has anterior segment signs including coniunctival 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.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2013年第4期384-387,共4页
Chinese Journal of Ocular Fundus Diseases
基金
基金项目：重庆市留学回国人员启动基金（CSTC,2010BB5034）
第三军医大学校管课题（2009XHG11）
关键词
巩膜炎
诊断
巩膜炎
治疗
疾病特征
超声检查
磁共振成像
Scleritis/diagnosis
Scleritis/therapy
Disease attributes
UltrasonographyMagnetic resonance imaging
