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帝京大学急性视网膜坏死的单中心病例系列:临床特征与治疗结果

A Single-Center Case Series of Acute Retinal Necrosis at Teikyo University: Clinical Characteristics and Treatment Outcomes.

作者信息

Mimura Tatsuya, Mizota Atsushi, Watanabe Emiko, Terauchi Gaku, Kawashima Makoto, Inoue Yuji

机构信息

Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, JPN.

Department of Ophthalmology, Nishikasai Inouye Eye Hospital, Tokyo, JPN.

出版信息

Cureus. 2024 Jun 13;16(6):e62343. doi: 10.7759/cureus.62343. eCollection 2024 Jun.

DOI:10.7759/cureus.62343
PMID:39011222
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11247251/
Abstract

Aim To evaluate the clinical characteristics, treatment course, and prognosis of patients with acute retinal necrosis (ARN), which can rapidly progress and cause severe vision loss. Design Single-center retrospective case series. Subjects and methods Six patients and seven eyes diagnosed with ARN at Teikyo University Hospital were included in this study. The clinical presentation and treatment prognosis were investigated based on data obtained from medical records. Results The mean age of the patients at the initial diagnosis was 63.6 years. Although the mean Logarithm of the Minimum Angle of Resolution (LogMAR) visual acuity tended to decrease from 0.77 at the first visit to 1.29 at the last visit, the difference was not statistically significant. Intraocular manifestations observed during the study period included ocular hypertension (14.3%), anterior uveitis (100.0%), retinal hemorrhage (71.4%), vitreous opacity (100.0%), retinal exudative vasculitis (85.7%), optic nerve atrophy (85.7%), retinal vascular occlusion (85.7%), choroidal atrophy (85.7%), macular edema (100.0%), subretinal fluid in the macula (71.4%), and retinal detachment (85.7%). Treatment modalities included oral and intravitreal antivirals (85.7%), antiplatelet medications (85.7%), steroid eye drops (85.7%), subcapsular (57.1%) and vitreous (42.9%) steroid injections, oral steroids (71.4%), and surgical intervention (85.7%). Vitrectomy led to retinal recovery in all five eyes that underwent the procedure. Conclusions The visual prognosis of patients with ARN is poor, particularly in those with preexisting visual impairment. Early detection coupled with antiviral therapy and prompt surgical intervention have been identified as potential factors that influence visual outcomes. Given the severity of ARN, collecting data from multiple centers could aid in devising future diagnostic and therapeutic strategies.

摘要

目的 评估急性视网膜坏死(ARN)患者的临床特征、病程及预后,ARN可迅速进展并导致严重视力丧失。设计 单中心回顾性病例系列研究。对象与方法 本研究纳入了东京医科大学医院诊断为ARN的6例患者及7只眼。基于病历数据调查临床表现及治疗预后。结果 患者初诊时的平均年龄为63.6岁。尽管平均最小分辨角对数(LogMAR)视力从首次就诊时的0.77有下降至末次就诊时1.29的趋势,但差异无统计学意义。研究期间观察到的眼内表现包括高眼压(14.3%)、前葡萄膜炎(100.0%)、视网膜出血(71.4%)、玻璃体混浊(100.0%)、视网膜渗出性血管炎(85.7%)、视神经萎缩(85.7%)、视网膜血管阻塞(85.7%)、脉络膜萎缩(85.7%)、黄斑水肿(100.0%)、黄斑区视网膜下液(71.4%)及视网膜脱离(85.7%)。治疗方式包括口服及玻璃体内抗病毒药物(85.7%)、抗血小板药物(85.7%)、类固醇眼药水(85.7%)、囊下(57.1%)及玻璃体(42.9%)类固醇注射、口服类固醇(71.4%)及手术干预(85.7%)。玻璃体切除术使接受该手术的5只眼中的视网膜均得以恢复。结论 ARN患者的视力预后较差,尤其是那些已有视力损害的患者。早期发现并联合抗病毒治疗及及时的手术干预已被确定为影响视力结果的潜在因素。鉴于ARN的严重性,从多个中心收集数据有助于制定未来的诊断和治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97d9/11247251/3546756a3d2d/cureus-0016-00000062343-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97d9/11247251/3546756a3d2d/cureus-0016-00000062343-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97d9/11247251/3546756a3d2d/cureus-0016-00000062343-i01.jpg

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Acute retinal necrosis in a patient with cervical malignant tumor treated with sintilimab: a case report and literature review.西妥昔单抗治疗颈恶性肿瘤致急性视网膜坏死 1 例并文献复习
Front Immunol. 2024 Jan 23;15:1301329. doi: 10.3389/fimmu.2024.1301329. eCollection 2024.
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First-line management of necrotizing herpetic retinitis by prioritizing the investigation of immune status and prognostic factors for poor visual outcomes.对于坏死性疱疹性视网膜炎,首先要调查免疫状态和预后不良的因素,以进行管理。
Int Ophthalmol. 2023 Jul;43(7):2545-2556. doi: 10.1007/s10792-023-02656-8. Epub 2023 Mar 15.
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Acute retinal necrosis. Management and visual outcomes: a case series.
急性视网膜坏死。治疗与视觉预后:病例系列
Int J Retina Vitreous. 2022 Sep 15;8(1):66. doi: 10.1186/s40942-022-00417-w.
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Efficacy of prophylactic laser retinopexy in acute retinal necrosis: A systematic review and meta-analysis.预防性激光视网膜光凝术治疗急性视网膜坏死的疗效:系统评价和荟萃分析。
Int Ophthalmol. 2022 May;42(5):1651-1660. doi: 10.1007/s10792-021-02131-2. Epub 2022 Mar 21.
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Acute Retinal Necrosis: Signs, Treatment, Complications and Outcome.急性视网膜坏死:体征、治疗、并发症及预后
Diagnostics (Basel). 2022 Feb 2;12(2):386. doi: 10.3390/diagnostics12020386.
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