Perentes Yannis, Van Tran T, Sickenberg Michel, Herbort Carl P
Inflammatory Eye Diseases, La Source Eye Center, Lausanne, Switzerland.
Ocul Immunol Inflamm. 2005 Apr-Jun;13(2-3):219-24. doi: 10.1080/09273940490518883.
Retrospective evaluation in a uveitic population of subretinal neovascular membranes (SRNMs), their occurrence, visual impact, and outcome in differently treated subgroups of patients.
Medical records of patients were reviewed and cases with SRNM (n = 12) identified. Intraocular inflammation was classified according to vitreous examination records as high (2+ cells), low (1/2+ to 1+ cells), or inactive (0 cells). Visual outcome was considered to be +VA (same or gain of one or more Snellen lines) or -VA (loss of Snellen lines). In nine cases, treatment consisted of the oral administration of high doses of corticosteroids (CST) for one month, tapered down in favorable situations (+VA or SRNM angiographic regression) or maintained at half the dose in unfavorable situations (-VA or SRNM angiographic progression) while additional laser therapies, including photodynamic therapy (PDT), transpupillary thermotherapy (TTT), or argon laser therapy (CLT)), were performed in some of the cases. The above treatment scheme was not applied in three cases (pre-PDT period; undiagnosed underlying uveitis treated without CST).
Twelve out of 648 patients (1.9%) with uveitis developed SRNM. The mean visual impact was 4.5 Snellen lines and mean follow-up time was 19.5 months. Two patients with high intraocular inflammation had a favorable visual outcome with CST alone. Eight patients with low intraocular inflammation had a favorable visual outcome with CST alone in three cases, with additional laser therapy in four cases (PDT in 3 cases and TTT in 1 case), and exclusively with PDT in one case (undiagnosed uveitis). Two patients with no intraocular inflammation had unfavorable visual outcome with CST alone (no PDT/TTT available).
SRNMs occurred as a rare complication of uveitis. Their visual outcome was relatively favorable. Although high doses of CST seem to be the first step in the management of SRNMs, alternative laser treatments should be considered early, especially in cases of absence or low intraocular inflammation.
对葡萄膜炎患者群体中的视网膜下新生血管膜（SRNM）进行回顾性评估，包括其发生率、对视力的影响以及不同治疗亚组患者的预后情况。
回顾患者的病历记录，确定患有SRNM的病例（n = 12）。根据玻璃体检查记录，将眼内炎症分为重度（2+细胞）、轻度（1/2+至1+细胞）或无活动（0细胞）。视力预后被视为视力提高（视力相同或提高一个或多个Snellen视力行数）或视力下降（Snellen视力行数降低）。9例患者接受了为期1个月的高剂量口服皮质类固醇（CST）治疗，在病情好转（视力提高或SRNM血管造影退缩）时逐渐减量，在病情不佳（视力下降或SRNM血管造影进展）时维持半量，同时部分病例还接受了包括光动力疗法（PDT）、经瞳孔温热疗法（TTT）或氩激光疗法（CLT）在内的额外激光治疗。上述治疗方案未应用于3例患者（PDT治疗前阶段；未诊断出潜在葡萄膜炎且未接受CST治疗）。
648例葡萄膜炎患者中有12例（1.9%）发生了SRNM。平均视力影响为4.5个Snellen视力行数，平均随访时间为19.5个月。2例重度眼内炎症患者仅接受CST治疗后视力预后良好。8例轻度眼内炎症患者中，3例仅接受CST治疗后视力预后良好，4例接受了额外激光治疗（3例接受PDT，1例接受TTT），1例（未诊断出葡萄膜炎）仅接受了PDT治疗。2例无眼内炎症患者仅接受CST治疗后视力预后不佳（未进行PDT/TTT治疗）。
SRNM是葡萄膜炎的一种罕见并发症。其视力预后相对良好。尽管高剂量CST似乎是SRNM治疗的第一步，但应尽早考虑替代激光治疗，尤其是在眼内炎症缺乏或较轻的情况下。
