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结节性葡萄膜炎:一个引人入胜的挑战。

Sarcoid Uveitis: An Intriguing Challenger.

机构信息

Uveitis and Eye Inflammatory Diseases Referral Center, Rapallo Hospital, 16033 Genova, Italy.

Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy.

出版信息

Medicina (Kaunas). 2022 Jul 4;58(7):898. doi: 10.3390/medicina58070898.

Abstract

The purpose of our work is to describe the actual knowledge concerning etiopathogenesis, clinical manifestations, diagnostic procedures, complications and therapy of ocular sarcoidosis (OS). The study is based on a recent literature review and on the experience of our tertiary referral center. Data were retrospectively analyzed from the electronic medical records of 235 patients (461 eyes) suffering from a biopsy-proven ocular sarcoidosis. Middle-aged females presenting bilateral ocular involvement are mainly affected; eye involvement at onset is present in one-third of subjects. Uveitis subtype presentation ranges widely among different studies: panuveitis and multiple chorioretinal granulomas, retinal segmental vasculitis, intermediate uveitis and vitreitis, anterior uveitis with granulomatous mutton-fat keratic precipitates, iris nodules, and synechiae are the main ocular features. The most important complications are cataract, glaucoma, cystoid macular edema (CME), and epiretinal membrane. Therapy is based on the disease localization and the severity of systemic or ocular involvement. Local, intravitreal, or systemic steroids are the mainstay of treatment; refractory or partially responsive disease has to be treated with conventional and biologic immunosuppressants. In conclusion, we summarize the current knowledge and assessment of ophthalmological inflammatory manifestations (mainly uveitis) of OS, which permit an early diagnostic assay and a prompt treatment.

摘要

我们工作的目的是描述关于眼结节病(OS)的病因发病机制、临床表现、诊断程序、并发症和治疗的实际知识。该研究基于最近的文献复习和我们的三级转诊中心的经验。对 235 例(461 只眼)经活检证实患有眼结节病的患者的电子病历进行了回顾性分析。受影响的主要是中年女性,表现为双眼受累;三分之一的患者在发病时就有眼部受累。葡萄膜炎亚型在不同研究中的表现差异很大:全葡萄膜炎和多发性脉络膜视网膜肉芽肿、视网膜节段性血管炎、中间葡萄膜炎和玻璃体炎、前部葡萄膜炎伴肉芽肿性羊肉脂肪状角膜后沉着物、虹膜结节和虹膜后粘连是主要的眼部特征。最常见的并发症是白内障、青光眼、黄斑囊样水肿(CME)和视网膜前膜。治疗基于疾病的定位和全身或眼部受累的严重程度。局部、玻璃体内或全身类固醇是治疗的主要方法;对于难治性或部分反应性疾病,必须使用传统和生物免疫抑制剂进行治疗。总之,我们总结了 OS 眼部炎症表现(主要是葡萄膜炎)的最新知识和评估,这可以实现早期诊断和及时治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ead5/9316395/ed64d8c80380/medicina-58-00898-g001.jpg

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