Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
Department of Ophthalmology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Ohmiya-ku, Saitama, Saitama, 330-8503, Japan.
Jpn J Ophthalmol. 2020 Mar;64(2):150-159. doi: 10.1007/s10384-020-00717-4. Epub 2020 Feb 3.
Retinal vasculitis and occlusive changes are important signs of posterior uveitis and are possible diagnostic markers for uveitis. However, the frequency of arteritis and phlebitis in various uveitis entities, including infectious uveitis (IU) and non-infectious uveitis (NIU), have not been systematically investigated.
Retrospective.
We investigated the frequency of retinal vascular inflammatory and occlusive changes in patients with IU and NIU. The study included 283 patients with intermediate, posterior, or pan-uveitis who were diagnosed with IU (presumed tuberculous uveitis, acute retinal necrosis, cytomegalovirus retinitis, human T-cell lymphotropic virus type 1-associated uveitis, toxoplasmic retinitis, syphilitic uveitis, rubella virus-associated uveitis, fungal endophthalmitis, and bacterial endophthalmitis) or NIU (sarcoidosis, Behçet's disease, Vogt-Koyanagi-Harada disease, human leukocyte antigen-B27-associated uveitis, systemic lupus erythematosus retinopathy, psoriatic uveitis, rheumatoid arthritis/collagen disease-associated uveitis, multiple sclerosis-associated uveitis, and sympathetic ophthalmia). All patients underwent fluorescein angiography (FA) and color photography examinations of the fundus. Presence of inflammatory and occlusive changes was determined by FA images.
Significantly higher positive ratios of phlebitis, vein sheathing, vein occlusion, arteritis, artery sheathing, artery occlusion, and avascular areas were observed in the IU group than in the NIU group (p < 0.05). Notably, the discrepancy between IU and NIU was prominent with regard to retinal arterial changes (arteritis [57.9% vs 11.2%], inflammatory artery sheathing [33.7% vs 0%], and artery occlusion [22.1% vs 3.7%], respectively; p < 0.0001).
Findings of vasculitis and occlusion, especially in retinal arteries, in FA strongly suggest an infectious origin of active uveitis.
视网膜血管炎和闭塞性改变是后葡萄膜炎的重要征象，也是葡萄膜炎的可能诊断标志物。然而，各种葡萄膜炎实体（包括感染性葡萄膜炎[IU]和非感染性葡萄膜炎[NIU]）中动脉炎和静脉炎的频率尚未得到系统研究。
回顾性。
我们研究了 IU 和 NIU 患者视网膜血管炎症和闭塞性改变的频率。该研究纳入了 283 名患有中间型、后型或全葡萄膜炎的患者，这些患者被诊断为 IU（推测性结核性葡萄膜炎、急性视网膜坏死、巨细胞病毒视网膜炎、人 T 细胞白血病病毒 1 型相关葡萄膜炎、弓形体病、梅毒性葡萄膜炎、风疹病毒相关性葡萄膜炎、真菌性眼内炎和细菌性眼内炎）或 NIU（结节病、贝切特病、Vogt-Koyanagi-Harada 病、人类白细胞抗原-B27 相关葡萄膜炎、系统性红斑狼疮性视网膜病变、银屑病性葡萄膜炎、类风湿关节炎/胶原病相关葡萄膜炎、多发性硬化症相关葡萄膜炎和交感性眼炎）。所有患者均行荧光素血管造影（FA）和眼底彩色摄影检查。通过 FA 图像确定炎症和闭塞性改变的存在。
与 NIU 组相比，IU 组的静脉炎、静脉鞘、静脉闭塞、动脉炎、动脉鞘、动脉闭塞和无血管区的阳性率明显更高（p<0.05）。值得注意的是，IU 和 NIU 之间在视网膜动脉变化方面存在明显差异（动脉炎[57.9%比 11.2%]、炎症性动脉鞘[33.7%比 0%]和动脉闭塞[22.1%比 3.7%]；p<0.0001）。
FA 中发现的血管炎和闭塞，尤其是在视网膜动脉中，强烈提示活动性葡萄膜炎的感染性起源。
