Baltatzis Stefanos, Romero-Rangel Tatiana, Foster C Stephen
Ocular Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Graefes Arch Clin Exp Ophthalmol. 2003 Jan;241(1):2-7. doi: 10.1007/s00417-002-0569-5. Epub 2002 Dec 18.
The purpose of this study was to examine the importance of considering the differential diagnosis for patients with sectorial keratitis and uveitis by case summary and literature review.
A retrospective review of patients with sectorial keratitis and uveitis seen at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary and a summary of the diagnoses of cases with similar ocular findings that have been reported in the literature.
Data on six patients with sectorial keratitis and uveitis were reviewed. Four patients were female and two were male, ages 21-50 years. All were eventually diagnosed with herpes simplex viral stromal sectorial keratitis. The corneal infiltrates were most common in the superior corneal quadrants, located in the posterior corneal layers. Anterior non-granulomatous uveitis was present in all cases. One case had bilateral ocular involvement. Five of the six patients responded to topical steroids and antiviral treatment. Immunomodulation with methotrexate, cyclosporine, and systemic prednisone was required in one patient. Glaucoma was a complication in six of the seven eyes. Five patients developed corneal scarring, localized in the anterior and mid-stroma.
The differential diagnosis of sectorial keratitis and uveitis is limited. The entities included in the differential are diverse; some of them threaten not only vision but also life. It is important for the ophthalmologist to be familiar with these entities, in order to pursue pertinent diagnostic investigations and arrive at an accurate diagnosis and institute appropriate management.
本研究旨在通过病例总结和文献回顾，探讨扇形角膜炎合并葡萄膜炎患者进行鉴别诊断的重要性。
对在马萨诸塞州眼耳医院眼免疫与葡萄膜炎科就诊的扇形角膜炎合并葡萄膜炎患者进行回顾性研究，并总结文献中报道的具有相似眼部表现病例的诊断情况。
对6例扇形角膜炎合并葡萄膜炎患者的数据进行了回顾。4例为女性，2例为男性，年龄在21至50岁之间。所有患者最终均被诊断为单纯疱疹病毒性基质性扇形角膜炎。角膜浸润最常见于角膜上象限，位于角膜后层。所有病例均存在前葡萄膜炎，且无肉芽肿形成。1例患者双眼受累。6例患者中有5例对局部类固醇和抗病毒治疗有反应。1例患者需要使用甲氨蝶呤、环孢素和全身泼尼松进行免疫调节。青光眼是7只眼中6只眼的并发症。5例患者出现角膜瘢痕，局限于角膜前层和中层。
扇形角膜炎合并葡萄膜炎的鉴别诊断范围有限。鉴别诊断所涉及的疾病种类多样；其中一些不仅威胁视力，还危及生命。眼科医生熟悉这些疾病很重要，以便进行相关的诊断检查，做出准确诊断并制定适当的治疗方案。
