弗吉尼亚州的感染性葡萄膜炎。
Infectious uveitis in Virginia.
作者信息
Engelhard Stephanie B, Haddad Zeina, Bajwa Asima, Patrie James, Xin Wenjun, Reddy Ashvini K
机构信息
Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
出版信息
Clin Ophthalmol. 2015 Aug 28;9:1589-94. doi: 10.2147/OPTH.S86578. eCollection 2015.
PURPOSE
To report the causes, clinical features, and outcomes of infectious uveitis in patients managed in a mid-Atlantic tertiary care center.
METHODS
Retrospective, observational study of infectious uveitis patients seen at the University of Virginia from 1984 to 2014.
RESULTS
Seventy-seven of 491 patients (15.7%) were diagnosed with infectious uveitis (mean age 58 years, 71.4% female, 76.6% Caucasian). The mean follow-up was 5 years. Anterior uveitis was the most common anatomic classification (39 patients, 50.6%) followed by panuveitis (20 patients, 26.0%) and posterior uveitis (18 patients, 23.4%). The most common infectious etiology was herpetic anterior uveitis (37 patients, 48.1%) followed by toxoplasma uveitis (14 patients, 18.2%). The most prevalent viral pathogen was varicella-zoster virus (21 patients, 27.3%) followed by herpes simplex virus (20 patients, 26.0%). Acute retinal necrosis (ARN) was diagnosed in 14 patients (18.2%). Aqueous humor yielded an etiologic diagnosis in seven (50%) of ARN patients, four of whom tested positive for cytomegalovirus and three for varicella-zoster virus. On presentation, 43 patients (55.8%) had a visual acuity (VA) better than 20/40 and 17 (22.1%) had a VA worse than 20/200. VA at the final follow-up was better than 20/40 in 39 patients (50.6%) and worse than 20/200 in 22 patients (28.6%). In all, 16 (20.8%) and 10 (13.0%) patients required cataract and vitrectomy surgery, respectively. A total of 14 patients (18.2%) were on glaucoma topical treatment and four (5.2%) required glaucoma surgery.
CONCLUSION
The most common type of infectious uveitis seen over the study period was herpetic anterior uveitis secondary to varicella-zoster virus or herpes simplex virus, found to be most prevalent in patients over 60 years of age. This finding is comparable to other American epidemiologic studies. Ocular toxoplasmosis and ARN were also common causes of infectious uveitis. In all, 50.6% of patients had a VA better than 20/40 at the final follow-up visit, indicating the importance of prompt referral and appropriate treatment.
目的
报告在大西洋中部一家三级医疗中心接受治疗的感染性葡萄膜炎患者的病因、临床特征及治疗结果。
方法
对1984年至2014年在弗吉尼亚大学就诊的感染性葡萄膜炎患者进行回顾性观察研究。
结果
491例患者中有77例（15.7%）被诊断为感染性葡萄膜炎（平均年龄58岁，女性占71.4%，白种人占76.6%）。平均随访时间为5年。前葡萄膜炎是最常见的解剖学分类（39例，50.6%），其次是全葡萄膜炎（20例，26.0%）和后葡萄膜炎（18例，23.4%）。最常见的感染病因是疱疹性前葡萄膜炎（37例，48.1%），其次是弓形虫性葡萄膜炎（14例，18.2%）。最常见的病毒病原体是水痘-带状疱疹病毒（21例，27.3%），其次是单纯疱疹病毒（20例，26.0%）。14例患者（18.2%）被诊断为急性视网膜坏死（ARN）。房水检查使7例（50%）ARN患者获得病因诊断，其中4例巨细胞病毒检测呈阳性，3例水痘-带状疱疹病毒检测呈阳性。就诊时，43例患者（55.8%）视力（VA）优于20/40，17例（22.1%）视力差于20/200。末次随访时，39例患者（50.6%）视力优于20/40，22例患者（28.6%）视力差于20/200。总共16例（20.8%）和10例（13.0%）患者分别需要进行白内障和玻璃体切割手术。共有14例患者（18.2%）接受青光眼局部治疗，4例（5.2%）需要进行青光眼手术。
结论
在研究期间观察到的最常见的感染性葡萄膜炎类型是由水痘-带状疱疹病毒或单纯疱疹病毒引起的疱疹性前葡萄膜炎，在60岁以上患者中最为常见。这一发现与其他美国流行病学研究结果相当。眼部弓形虫病和ARN也是感染性葡萄膜炎的常见病因。总体而言，50.6%的患者在末次随访时视力优于20/40，这表明及时转诊和适当治疗的重要性。
Zotero 插件