眼部结节病：新的诊断方法与治疗
Ocular sarcoidosis: new diagnostic modalities and treatment.
作者信息
Yang Sung J, Salek Sherveen, Rosenbaum James T
机构信息
aDepartment of Ophthalmology, Gangneung Asan Hospital, Ulsan University, South Korea bCasey Eye Institute cDivision of Arthritis and Rheumatic Diseases, Oregon Health & Science University dLegacy Devers Eye Institute, Portland, Oregon, USA.
出版信息
Curr Opin Pulm Med. 2017 Sep;23(5):458-467. doi: 10.1097/MCP.0000000000000409.
PURPOSE OF REVIEW
Ocular involvement in sarcoidosis is present in up to 80% of patients and is frequently manifested before diagnosis of the underlying systemic disease. Considering the therapeutic consequences, early diagnosis of the underlying disease is advantageous in patients presenting with ocular inflammation. There are several ocular findings suggestive of underlying sarcoidosis, such as granulomatous keratic precipitates, iris nodules, cells in the vitreous humor known as snowballs and snowbanks, and retinal periphlebitis. High suspicion is crucial for the diagnosis of sarcoidosis. This review on ocular sarcoidosis will mainly focus on new diagnostic and treatment modalities.
RECENT FINDINGS
Recent studies found possible new diagnostic indicators for the diagnosis of ocular sarcoidosis which include not only serum profiles but also vitreous sample analysis. Ophthalmologic imaging techniques have improved to investigate the ocular structure in detail. Results from recent uveitis clinical trials have included sarcoidosis as an underlying cause and have reported positive results.
SUMMARY
The diagnosis of ocular sarcoidosis can be challenging in some cases. High suspicion is important to diagnose ocular sarcoidosis with various laboratory and ophthalmic tools. There are many possible options for the treatment of ocular sarcoidosis including various biologic agents.
综述目的
结节病累及眼部的情况在高达80%的患者中存在，且常在潜在全身性疾病诊断之前出现。考虑到治疗后果，对于出现眼部炎症的患者，早期诊断潜在疾病是有益的。有几种眼部表现提示潜在的结节病，如肉芽肿性角膜后沉着物、虹膜结节、玻璃体内的细胞（称为雪球和雪堤）以及视网膜静脉周围炎。高度怀疑对于结节病的诊断至关重要。本眼部结节病综述将主要聚焦于新的诊断和治疗方式。
最新发现
近期研究发现了可能用于诊断眼部结节病的新诊断指标，这不仅包括血清指标，还包括玻璃体样本分析。眼科成像技术已得到改进，可详细研究眼部结构。近期葡萄膜炎临床试验的结果已将结节病作为潜在病因纳入，并报告了阳性结果。
总结
眼部结节病的诊断在某些情况下可能具有挑战性。高度怀疑对于借助各种实验室和眼科工具诊断眼部结节病很重要。眼部结节病的治疗有许多可能的选择，包括各种生物制剂。
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