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[视网膜血管炎与全身性疾病]

[Retinal vasculitis and systemic diseases].

作者信息

Gascon P, Jarrot P-A, Matonti F, Kaplanski G

机构信息

Service d'ophtalmologie, Aix-Marseille université, CHU Nord, 13015 Marseille, France.

Service de médecine interne et immunologie clinique, hôpital de la Conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France.

出版信息

Rev Med Interne. 2018 Sep;39(9):721-727. doi: 10.1016/j.revmed.2018.04.013. Epub 2018 Jun 20.

Abstract

Retinal vasculitis (RV) is an inflammation of retinal blood vessels that can be associated with uveitis or be isolated, and can induce vascular occlusion and retinal ischemia. Visual acuity can be severely affected in case of macular involvement or neovessel formation. The diagnosis relies on fundoscopy and fluorescein angiography. Systemic diseases may be associated with RV, the most frequently encountered are Behçet's disease, sarcoidosis or multiple sclerosis, all predominantly associated with venous involvement, whereas systemic lupus erythematosus and necrotizing vasculitis are less frequently observed and predominantly associated with arterial or mixed vasculitis. Treatments are usually aggressive in order to preserve a good visual acuity and to reduce retinal inflammation and chronic ischemia. Steroids, immunosuppressive drugs, retinal laser photocoagulation, intravitreal anti-VEGF injections are usual treatments and more recently, anti-TNFalpha monoclonal therapeutic antibodies have been shown to be very successful.

摘要

视网膜血管炎(RV)是一种视网膜血管炎症,可与葡萄膜炎相关或单独出现,并可导致血管闭塞和视网膜缺血。若黄斑受累或形成新血管,视力会受到严重影响。诊断依赖于眼底镜检查和荧光素血管造影。全身性疾病可能与RV相关,最常见的是白塞病、结节病或多发性硬化症,所有这些主要与静脉受累相关,而系统性红斑狼疮和坏死性血管炎较少见,主要与动脉或混合性血管炎相关。为了保持良好的视力并减轻视网膜炎症和慢性缺血,治疗通常较为积极。类固醇、免疫抑制药物、视网膜激光光凝、玻璃体内抗血管内皮生长因子(VEGF)注射是常用治疗方法,最近,抗TNFα单克隆治疗抗体已被证明非常有效。

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