Pichi Francesco, Srivastava Sunil K, Nucci Paolo, Baynes Kimberly, Neri Piergiorgio, Lowder Careen Y
*Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; †San Giuseppe Hospital, University Eye Clinic, Milan, Italy; and ‡The Ocular Immunology Service, The Eye Clinic, Polytechnic University of Marche, Ancona, Italy.
Retina. 2017 Nov;37(11):2167-2174. doi: 10.1097/IAE.0000000000001463.
To examine cases of intermediate uveitis complicated by retinoschisis and review the pathogenetic hypothesis.
A retrospective chart review of patients with intermediate uveitis. Data were collected at three uveitis referral centers on sex, age, best-corrected visual acuity, degree of vitritis, extent and location of snowbanking, presence of hard exudates, neovascularization, vitreous hemorrhage, and extent and nature of retinal elevations.
A series of 23 eyes of 20 patients were examined; patient's age ranged from 10 years to 70 years and follow-up period from 8 months to 6 years. Twenty-two eyes had retinoschisis (95.6%), and 1 had retinoschisis associated with serous retinal detachment (4.3%). Extensive inferior pars plana exudates with snowbanking were present in 12 eyes (52.2%), whereas 3 eyes had inferior snowballs over the elevated retina. Neovascularization of the vitreous base accompanied by vitreous hemorrhage occurred in one eye. There was no coexisting macular pathology in 16 eyes, whereas 4 eyes had cystoid macular edema.
The appearance of peripheral retinoschisis in this series of uncontrolled intermediate uveitis patients seems to be secondary to a complex balance between the persistent fluorescein leakage, a subclinical peripheral ischemia, and the constant low-grade vitreous inflammation that causes vitreous shrinkage and traction. The results of this study suggest that the absence of macroscopic changes in the retina does not preclude ischemic peripheral abnormalities, and the detection of a peripheral retinoschisis in an intermediate uveitis patient with active fluorescein leakage must suggest the need for a more aggressive form of treatment despite the good visual acuity.
研究中间葡萄膜炎合并视网膜劈裂的病例，并回顾其发病机制假说。
对中间葡萄膜炎患者进行回顾性病历分析。在三个葡萄膜炎转诊中心收集患者的性别、年龄、最佳矫正视力、玻璃体炎症程度、雪堤样病变的范围和位置、硬性渗出物的存在情况、新生血管形成、玻璃体积血以及视网膜隆起的范围和性质等数据。
检查了20例患者的23只眼；患者年龄在10岁至70岁之间，随访时间为8个月至6年。22只眼有视网膜劈裂（95.6%），1只眼有视网膜劈裂合并浆液性视网膜脱离（4.3%）。12只眼（52.2%）有广泛的下方平坦部渗出伴雪堤样病变，而3只眼在隆起的视网膜上有下方雪球样病变。1只眼出现玻璃体基底部新生血管形成并伴有玻璃体积血。16只眼没有并存的黄斑病变，而4只眼有黄斑囊样水肿。
在这组未经控制的中间葡萄膜炎患者中，周边视网膜劈裂的出现似乎继发于持续的荧光素渗漏、亚临床周边缺血以及导致玻璃体收缩和牵引的持续低度玻璃体炎症之间的复杂平衡。本研究结果表明，视网膜无宏观变化并不排除周边缺血性异常，在荧光素渗漏活跃的中间葡萄膜炎患者中检测到周边视网膜劈裂，尽管视力良好，也必须提示需要采取更积极的治疗方式。
