Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Ophthalmology, Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Acta Ophthalmol. 2018 Jun;96(4):e524-e532. doi: 10.1111/aos.13684. Epub 2018 Mar 5.
To characterize cat-scratch disease (CSD) ocular manifestations and visual outcome and evaluate the effect of systemic antibiotics and corticosteroids on final visual acuity (VA).
Multicentre retrospective cohort study. Medical records of 86 patients with ocular disease (107 eyes) of 3222 patients identified in a national CSD surveillance study were reviewed.
Mean age was 35.1 ± 14.2 years. Median follow-up was 20 weeks (range 1-806 weeks). Of 94/107 (88%) eyes with swollen disc, 60 (64%) had neuroretinitis at presentation, 14 (15%) developed neuroretinitis during follow-up, and 20 (21%) were diagnosed with inflammatory disc oedema. Optic nerve head lesion, uveitis, optic neuropathy and retinal vessel occlusion were found in 43 (40%), 38 (36%), 34 (33%) and 8 (7%) eyes, respectively. Good VA (better than 20/40), moderate vision loss (20/40-20/200) and severe vision loss (worse than 20/200) were found in 26/79 (33%), 35/79 (44%) and 18/79 (23%) eyes at baseline and in 63/79 (80%), 11/79 (14%) and 5/79 (6%) eyes at final follow-up, respectively (p < 0.001). Significant VA improvement (defined as improvement of ≥3 Snellen lines at final follow-up compared to baseline) occurred in 12/24 (50%) eyes treated with antibiotics compared with 14/16 (88%) eyes treated with antibiotics and corticosteroids (p = 0.02). Multivariate logistic regression was suggestive of the same association (odds ratio 7.0; 95% CI 1.3-37.7; p = 0.024).
Optic nerve head lesion is a common and unique manifestation of ocular CSD. Most patients improved and had final good VA. Combined antibiotics and corticosteroid treatment was associated with a better visual outcome.
描述猫抓病（CSD）眼部表现和视力结果，并评估全身抗生素和皮质类固醇对最终视力（VA）的影响。
多中心回顾性队列研究。对全国 CSD 监测研究中确定的 3222 例患者的眼部疾病（107 只眼）86 例患者的病历进行了回顾。
平均年龄为 35.1±14.2 岁。中位随访时间为 20 周（范围 1-806 周）。在 94/107（88%）只视盘肿胀的眼中，60 只（64%）在就诊时出现神经视网膜炎，14 只（15%）在随访中出现神经视网膜炎，20 只（21%）被诊断为炎症性视盘水肿。视神经头病变、葡萄膜炎、视神经病变和视网膜血管阻塞分别在 43 只（40%）、38 只（36%）、34 只（33%）和 8 只（7%）眼中发现。在基线时，79 只（33%）、35 只（44%）和 18 只（23%）眼中的视力较好（优于 20/40），中度视力丧失（20/40-20/200）和严重视力丧失（差于 20/200），在最终随访时，63 只（80%）、11 只（14%）和 5 只（6%）眼中的视力分别改善（与基线相比，最终随访时视力改善≥3 行 Snellen）（p<0.001）。与仅用抗生素治疗的 12/24（50%）只眼相比，联合使用抗生素和皮质类固醇治疗的 14/16（88%）只眼中视力改善更为显著（p=0.02）。多变量逻辑回归提示存在相同的关联（优势比 7.0；95%CI 1.3-37.7；p=0.024）。
视神经头病变是眼部 CSD 的常见且独特表现。大多数患者得到改善，最终视力良好。联合使用抗生素和皮质类固醇治疗与更好的视力结果相关。
