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非眼科医生的葡萄膜炎

Uveitis for the non-ophthalmologist.

机构信息

Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA

Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA.

出版信息

BMJ. 2021 Feb 3;372:m4979. doi: 10.1136/bmj.m4979.

Abstract

The uveitides are a heterogeneous group of diseases characterized by inflammation inside the eye. The uveitides are classified as infectious or non-infectious. The non-infectious uveitides, which are presumed to be immune mediated, can be further divided into those that are associated with a known systemic disease and those that are eye limited,-ie, not associated with a systemic disease. The ophthalmologist identifies the specific uveitic entity by medical history, clinical examination, and ocular imaging, as well as supplemental laboratory testing, if indicated. Treatment of the infectious uveitides is tailored to the particular infectious organism and may include regional and/or systemic medication. First line treatment for non-infectious uveitides is corticosteroids that can be administered topically, as regional injections or surgical implants, or systemically. Systemic immunosuppressive therapy is used in patients with severe disease who cannot tolerate corticosteroids, require chronic corticosteroids at >7.5 mg/day prednisone, or in whom the disease is known to respond better to immunosuppression. Management of many of these diseases is optimized by coordination between the ophthalmologist and rheumatologist or internist.

摘要

葡萄膜炎是一组以眼内炎症为特征的异质性疾病。葡萄膜炎可分为感染性和非感染性。非感染性葡萄膜炎,推测为免疫介导,可进一步分为与已知全身性疾病相关和眼部局限性(即与全身性疾病无关)。眼科医生通过病史、临床检查和眼部影像学检查,以及必要时的补充实验室检查,确定特定的葡萄膜炎实体。感染性葡萄膜炎的治疗针对特定的感染病原体,可能包括局部和/或全身药物治疗。非感染性葡萄膜炎的一线治疗是皮质类固醇,可以局部给药,如局部注射或手术植入,或全身给药。对于不能耐受皮质类固醇、需要每天 >7.5 毫克泼尼松龙的慢性皮质类固醇治疗或已知对免疫抑制反应更好的严重疾病患者,使用全身性免疫抑制治疗。眼科医生与风湿病学家或内科医生之间的协调可以优化许多这些疾病的管理。

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