梅毒性葡萄膜炎的预后因素。

Prognostic Factors in Syphilitic Uveitis.

机构信息

Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France.

Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France.

出版信息

Ophthalmology. 2017 Dec;124(12):1808-1816. doi: 10.1016/j.ophtha.2017.06.003. Epub 2017 Aug 2.

DOI:10.1016/j.ophtha.2017.06.003

PMID:28779905

Abstract

PURPOSE

To identify predictors of treatment success in syphilitic uveitis (SU).

DESIGN

Retrospective multicentric analysis of patients treated for SU.

PARTICIPANTS

A total of 95 eyes (66 patients, mean [standard deviation] aged 49 [12.5] years, 31 [47%] of whom were human immunodeficiency virus [HIV]+) were analyzed.

METHODS

Activity of SU was assessed at 1 week and 1 month after treatment onset, and at last follow-up. Improvement was defined by a ≥2-step decrease of both anterior chamber and vitreous haze inflammation levels, and by the size reduction in chorioretinal lesions.

MAIN OUTCOME MEASURES

Recovery was defined as the resolution of inflammation in all anatomic structures at 1 month.

RESULTS

Panuveitis and posterior uveitis were the most frequent findings. Inflammatory parameters were higher in HIV+ patients. Recovery was reported in 65% and 85% of eyes at 1 month and at last follow-up, respectively. In multivariate analysis, after adjusting for initial best-corrected visual acuity and the antimicrobial treatment regimen, clinical improvement at 1 week (corrected risk ratios [cRR], 3.5 [2.3-3.8]; P = 0.001) was predictive of recovery at 1 month, whereas the use of periocular dexamethasone injections (cRR, 0.05 [0.02-0.6]; P = 0.01) and methylprednisolone pulses negatively affected the outcomes of eyes.

CONCLUSIONS

Early improvement is the strongest predictor of ophthalmological recovery in SU.

摘要

目的

确定梅毒性葡萄膜炎（SU）治疗成功的预测因素。

设计

SU 治疗患者的回顾性多中心分析。

参与者

共分析了 95 只眼（66 例患者，平均年龄[标准差]为 49[12.5]岁，其中 31 例[47%]为人类免疫缺陷病毒[HIV]+）。

方法

在治疗开始后 1 周和 1 个月以及最后一次随访时评估 SU 的活动性。改善定义为前房和玻璃体混浊炎症水平均降低 2 步以上，以及脉络膜视网膜病变缩小。

主要观察指标

恢复定义为 1 个月时所有解剖结构的炎症消退。

结果

全葡萄膜炎和后葡萄膜炎是最常见的表现。HIV+患者的炎症参数更高。在 1 个月和最后一次随访时，分别有 65%和 85%的眼报告恢复。多变量分析显示，在调整初始最佳矫正视力和抗菌治疗方案后，1 周时的临床改善（校正风险比[cRR]，3.5[2.3-3.8]；P=0.001）可预测 1 个月时的恢复，而眼周地塞米松注射（cRR，0.05[0.02-0.6]；P=0.01）和甲基强的松龙脉冲的使用对眼的结局产生负面影响。