Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Ophthalmology. 2012 Nov;119(11):2334-42. doi: 10.1016/j.ophtha.2012.05.034. Epub 2012 Aug 11.
To describe the clinical features, course, and outcome in tubercular serpiginous-like choroiditis.
Retrospective cohort study.
A total of 105 patients (141 eyes) between May 2002 and July 2010.
Patients had the following inclusion criteria: (1) complete clinical records and digital fundus images at baseline and follow-up visits, (2) positive tuberculin skin test or QuantiFERON-TB Gold (Cellestis International Pty Ltd. Chadstone, Victoria, Australia) test result, (3) active serpiginous-like choroiditis in at least 1 eye, (4) all known causes of infectious (except tuberculosis) and noninfectious uveitis ruled out, and (5) a minimum of 9 months of follow-up from initiation of treatment that included antitubercular therapy (ATT) with oral corticosteroids (93 patients) or corticosteroids alone (12 patients).
Clinical characteristics and evolution of choroiditis lesions from the acute to healed stage, recurrence, visual outcome, and complications.
Mean age was 33 ± 9.3 years (range, 12-54 years; 75 male and 30 female patients). Serpiginous-like choroiditis was bilateral (at least 1 eye active) in 66 patients (62.9%). Of 171 affected eyes, 141 (82.45%) had active lesions at presentation. Of 141 eyes, 115 (81.56%) showed vitreous inflammation. Lesions were multifocal in 133 eyes (94.3%), were noncontiguous to optic disc in 122 eyes (86.52%), and involved the macula in 125 eyes (88.65%). Of patients receiving ATT, all showed resolution of lesions and 9 (9.7%) developed recurrences (median follow-up, 21 months). In addition, 12 patients (12.9%) showed continued progression over a median 3.5 weeks after initiation of therapy. Of 12 patients treated with corticosteroids alone, none showed progression but 9 (75%) developed recurrence (median, 26.5 months). Final visual acuity of ≥ 6/12 was achieved in 108 eyes (76.60%) versus 72 eyes (51.06%) before treatment. Fovea was spared in 95 of 125 eyes (76%) with macular involvement. Five eyes (3.5%) developed choroidal neovascular membrane.
Tubercular serpiginous-like choroiditis presented as multifocal serpiginoid choroiditis affecting predominantly young to middle-aged men. It was frequently bilateral with vitreous inflammation and characterized by multifocal lesions that were noncontiguous to the optic disc and showed serpiginoid spread. Antitubercular therapy significantly reduced recurrences. Lesions responded to combined antitubercular and steroid therapy, usually spared fovea, and had a good final visual acuity.
描述结核性匐行性脉络膜炎的临床特征、病程和转归。
回顾性队列研究。
2002 年 5 月至 2010 年 7 月间共有 105 例（141 只眼）患者。
患者符合以下纳入标准：（1）基线和随访时有完整的临床记录和数字眼底图像；（2）结核菌素皮肤试验或 Quantiferon-TB Gold（Cellestis International Pty Ltd. Chadstone，维多利亚，澳大利亚）检测结果阳性；（3）至少 1 只眼存在活动性匐行性脉络膜炎；（4）排除所有已知的感染（除结核外）和非感染性葡萄膜炎的原因；（5）开始治疗后至少 9 个月的随访，包括抗结核治疗（ATT）联合口服皮质类固醇（93 例）或单独皮质类固醇（12 例）。
从急性到愈合阶段、复发、视力结果和并发症的脉络膜病变的临床特征和演变。
平均年龄为 33 ± 9.3 岁（范围，12-54 岁；75 例男性和 30 例女性患者）。66 例（62.9%）患者的匐行性脉络膜炎为双侧（至少 1 只眼活动）。171 只受累眼中，141 只（82.45%）在就诊时存在活动性病变。141 只眼中，115 只（81.56%）出现玻璃体炎症。133 只眼（94.3%）的病变呈多灶性，122 只眼（86.52%）与视盘不连续，125 只眼（88.65%）累及黄斑。接受 ATT 的患者中，所有患者的病变均得到缓解，9 例（9.7%）出现复发（中位随访时间，21 个月）。此外，12 例（12.9%）在开始治疗后 3.5 周内持续进展。单独接受皮质类固醇治疗的 12 例患者中，无一例出现进展，但 9 例（75%）出现复发（中位时间，26.5 个月）。治疗前视力≥6/12 的有 108 只眼（76.60%），而治疗前为 72 只眼（51.06%）。黄斑受累的 95 只眼（76%）中，黄斑未受累。5 只眼（3.5%）发生脉络膜新生血管膜。
结核性匐行性脉络膜炎表现为多灶性匐行性脉络膜炎，主要影响中青年男性。它常为双侧，伴有玻璃体炎症，其特征为多灶性病变，与视盘不连续，呈匐行性蔓延。抗结核治疗可显著减少复发。病变对联合抗结核和皮质类固醇治疗有反应，通常黄斑未受累，视力预后良好。
