Miyanaga Masaru, Kawaguchi Tatushi, Shimizu Kentaro, Miyata Kazunori, Mochizuki Manabu
Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8591, Japan.
Int Ophthalmol. 2007 Apr-Jun;27(2-3):183-8. doi: 10.1007/s10792-007-9076-3. Epub 2007 May 3.
To evaluate the importance of early cerebrospinal fluid (CSF)-guided diagnosis and early high-dose corticosteroid therapy on the complications and visual prognosis of Vogt-Koyanagi-Harada (VKH) disease.
Charts from patients with VKH disease who had been seen at Tokyo Medical and Dental University Hospital and Miyata Eye Hospital between 1994 and 2002 were retrospectively reviewed. The patients were classified into two groups. The first group (group A) consisted of patients who had received a full work-up including CSF examination and corticosteroid pulse therapy at the acute ophthalmic stage of disease. The second group (group B) consisted of patients who were referred to us by local ophthalmologists long after the disease onset, had not had a CSF examination and had been treated with low-dose systemic corticosteroids or topical corticosteroid therapy. The ocular complications, systemic complications and visual prognosis were compared between the two groups.
Twenty-two patients were included in group A and ten patients in group B. The initial diagnosis at the acute ophthalmic stage had been VKH disease in all patients of group A, while, in group B, the diagnosis was idiopathic uveitis in six patients (60%) initially. Frequency of recurrent uveitis and integumentary symptoms were significantly lower in group A. Intensity of sunset glow fundus was significantly more severe in group B. All eyes in group A obtained a final visual acuity of 0.8 or better, whereas 11 eyes (55%) in group B were below this level.
The results indicate that early diagnosis, helped by CSF examination and early high-dose corticosteroid therapy, decreased the complication rate and improved the visual prognosis.
评估早期脑脊液（CSF）引导下的诊断及早期大剂量皮质类固醇疗法对伏格特-小柳-原田（VKH）病并发症及视力预后的重要性。
回顾性分析1994年至2002年间在东京医科齿科大学医院和宫田眼科医院就诊的VKH病患者的病历。将患者分为两组。第一组（A组）包括在疾病急性眼科阶段接受了包括脑脊液检查和皮质类固醇脉冲疗法在内的全面检查的患者。第二组（B组）包括在疾病发作很久后由当地眼科医生转诊至我们这里、未进行脑脊液检查且接受低剂量全身皮质类固醇或局部皮质类固醇治疗的患者。比较两组患者的眼部并发症、全身并发症及视力预后。
A组纳入22例患者，B组纳入10例患者。A组所有患者在急性眼科阶段的初始诊断均为VKH病，而B组最初有6例患者（60%）的诊断为特发性葡萄膜炎。A组葡萄膜炎复发和皮肤症状的发生率显著更低。B组晚霞样眼底的严重程度显著更高。A组所有眼睛的最终视力均达到0.8或更好，而B组有11只眼睛（55%）低于该水平。
结果表明，在脑脊液检查及早期大剂量皮质类固醇疗法的辅助下进行早期诊断，可降低并发症发生率并改善视力预后。
