急性视网膜坏死预后与视网膜受累的关系。
Association Between Prognosis of Acute Retinal Necrosis and Retinal Involvement.
机构信息
İstanbul University, İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey.
出版信息
Turk J Ophthalmol. 2022 Dec 28;52(6):405-411. doi: 10.4274/tjo.galenos.2021.58609.
OBJECTIVES
The aims of this study were to describe the clinical presentation and treatment modalities of acute retinal necrosis (ARN) and to evaluate complications and clinical outcomes according to the extent of retinal involvement at initial presentation.
MATERIALS AND METHODS
The medical records of 52 patients diagnosed with ARN were reviewed and 48 were included in the study. Patients were categorized into two groups according to the extent of retinitis at presentation: retinal involvement of 1-2 quadrants (Group A) or 3-4 quadrants (Group B).
RESULTS
The mean age of the 14 women and 34 men at presentation was 51.3±13.6 years (range: 27-78). There were 40 unilateral and 8 bilateral cases. There were 11 eyes (19.6%) in Group A and 45 eyes (80.4%) in Group B. Eleven patients (22.9%) had a history of herpes simplex virus/varicella-zoster virus infection. One patient in Group A and 11 patients in Group B had received local or systemic corticosteroid therapy without concomitant antiviral treatment before referral. The median follow-up period was 29 months (range: 1-209) in Group A and 8.5 months (range: 0.75-209) in Group B. Mean visual acuity (VA) at presentation was 0.42±0.55 LogMAR (range: 0-2.0) in Group A and 1.28±0.95 LogMAR (range: 0-2.9) in Group B (p<0.05). The presence of endothelial keratic precipitates at presentation was significantly different between two groups (p=0.021). Retinal detachment (RD) occurred in 1 eye (9.1%) in Group A and 30 eyes (66.7%) in Group B (p<0.001). Optic disc pallor was seen in 36.4% (4/11) of eyes in Group A and 71.1% (32/45) of eyes in Group B (p=0.033). Other ocular complications were not significantly different between two groups. Mean final visual acuity was 0.29±0.41 LogMAR in Group A and 1.61±0.90 LogMAR in Group B (p<0.05).
CONCLUSION
The extent of retinal involvement at presentation affects visual outcomes and this shows the importance of early diagnosis and early initiation of antiviral treatment.
目的
本研究旨在描述急性视网膜坏死（ARN）的临床表现和治疗方式，并根据初诊时视网膜受累的范围评估并发症和临床结局。
材料和方法
回顾了 52 例诊断为 ARN 的患者的病历，其中 48 例纳入研究。根据初诊时视网膜炎的范围将患者分为两组：视网膜受累 1-2 象限（A 组）或 3-4 象限（B 组）。
结果
14 名女性和 34 名男性的初诊年龄为 51.3±13.6 岁（范围：27-78）。40 例为单侧，8 例为双侧。A 组 11 眼（19.6%），B 组 45 眼（80.4%）。11 例（22.9%）患者有单纯疱疹病毒/水痘带状疱疹病毒感染史。A 组 1 例和 B 组 11 例患者在转诊前接受了局部或全身皮质类固醇治疗，但未同时进行抗病毒治疗。A 组的中位随访时间为 29 个月（范围：1-209），B 组为 8.5 个月（范围：0.75-209）。A 组初诊时平均视力（VA）为 0.42±0.55 LogMAR（范围：0-2.0），B 组为 1.28±0.95 LogMAR（范围：0-2.9）（p<0.05）。两组初诊时角膜内皮有 keratic precipitates 的存在存在显著差异（p=0.021）。A 组 1 眼（9.1%）出现视网膜脱离（RD），B 组 30 眼（66.7%）出现 RD（p<0.001）。A 组 4 眼（36.4%）和 B 组 32 眼（71.1%）视盘苍白（p=0.033）。两组其他眼部并发症无显著差异。A 组平均最终视力为 0.29±0.41 LogMAR，B 组为 1.61±0.90 LogMAR（p<0.05）。
结论
初诊时视网膜受累的范围影响视力预后，这表明早期诊断和早期开始抗病毒治疗的重要性。
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