Kijlstra A
Dept. Ophthalmo-Immunology, The Netherlands Opthalmic Research Institute, Amsterdam, The Netherlands.
Eye (Lond). 1990;4 ( Pt 5):732-6. doi: 10.1038/eye.1990.104.
Accurate diagnosis of uveitis is of great importance since the treatment for the various uveitis entities may differ considerably. In a large number of cases the clinical picture is sufficient to make an adequate diagnosis. There are cases in which the diagnosis cannot be made on clinical grounds alone and support is needed from laboratory tests. Only a limited number of tests have been proven to be useful as a diagnostic or prognostic aid. These include HLA-B27 typing in patients presenting with anterior uveitis and testing for angiotensin converting enzyme and lysozyme in case of suspected sarcoid uveitis. Toxoplasma serology is only useful to exclude the diagnosis and a positive test has very low specific value. Analysis of local intraocular antibody production is a valuable tool to confirm a suspected clinical diagnosis in uveitis. It is now possible to analyse paired serum and aqueous samples for the presence of specific antibodies against toxoplasma, cytomegalovirus, herpes simplex virus and varicella zoster virus using commercially available kits. Of the patients retrospectively diagnosed as having toxoplasma chorioretinitis 75% were shown to have a positive antibody coefficient indicating specific intraocular antibody production. Local antibody production in the eye directed against CMV confirmed the suspected diagnosis of CMV retinitis in 50% of the AIDS patients investigated. Until now we have not been able to measure local antibody production against herpes simplex virus (26 samples tested). Two of three patients with acute retinal necrosis had a positive antibody coefficient against varicella zoster virus. Both of these patients even had a higher titre in the aqueous than in serum. Since the choice of treatment, in infectious uveitis, depends on the causative organisms, it is very important to confirm a suspected clinical diagnosis with aqueous humor analysis.
葡萄膜炎的准确诊断至关重要，因为针对不同类型葡萄膜炎的治疗可能差异很大。在大量病例中，临床表现足以做出充分诊断。但也有一些病例仅依靠临床依据无法做出诊断，需要实验室检查的支持。仅有少数检查被证明对诊断或预后评估有帮助。这些检查包括对前葡萄膜炎患者进行HLA - B27分型，以及在怀疑结节病性葡萄膜炎时检测血管紧张素转换酶和溶菌酶。弓形虫血清学仅有助于排除诊断，阳性检测结果的特异性很低。分析眼内局部抗体产生是确诊葡萄膜炎疑似临床诊断的重要工具。现在可以使用市售试剂盒分析配对的血清和房水样本中是否存在针对弓形虫、巨细胞病毒、单纯疱疹病毒和水痘带状疱疹病毒的特异性抗体。在回顾性诊断为弓形虫性脉络膜视网膜炎的患者中，75%显示抗体系数为阳性，表明有特异性眼内抗体产生。在接受调查的艾滋病患者中，眼内针对巨细胞病毒产生的局部抗体证实了50%患者疑似巨细胞病毒性视网膜炎的诊断。到目前为止，我们还无法检测针对单纯疱疹病毒的局部抗体产生情况（检测了26个样本）。三例急性视网膜坏死患者中有两例针对水痘带状疱疹病毒的抗体系数为阳性。这两名患者房水中的抗体滴度甚至高于血清中的滴度。由于在感染性葡萄膜炎中治疗方案的选择取决于致病微生物，因此通过房水分析来确诊疑似临床诊断非常重要。
