Soukiasian S H, Foster C S, Raizman M B
Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114.
Am J Ophthalmol. 1994 Nov 15;118(5):601-11. doi: 10.1016/s0002-9394(14)76575-4.
We treated 19 patients with anterior uveitis, episcleritis, or scleritis associated with inflammatory bowel disease. Adequate control of ocular inflammation was achieved in 16 patients (84%). Ocular inflammation was adequately controlled with corticosteroids alone, without systemic adverse effects, in only three patients, all of whom had anterior uveitis associated with ulcerative colitis. Systemic nonsteroidal anti-inflammatory drugs proved beneficial in six of seven patients, and one additional patient benefited from another anti-inflammatory drug (hydroxychloroquine sulfate). Systemic cytotoxic immunosuppressive therapy was used in the remaining seven patients, six of whom had bilateral disease. Ocular inflammation was controlled in six of these patients. Azathioprine was beneficial for scleritis but was less effective for anterior uveitis, especially in Crohn's disease, thus necessitating the use of another cytotoxic agent. HLA-B27-positive anterior uveitis was more refractory to corticosteroid therapy and was more likely to require systemic cytotoxic immunosuppressive therapy. With the medical and surgical strategies described, vision was improved or maintained in all patients in the study group.
我们对19例患有与炎症性肠病相关的前葡萄膜炎、巩膜炎或表层巩膜炎的患者进行了治疗。16例患者（84%）实现了眼部炎症的充分控制。仅3例患者仅用皮质类固醇就充分控制了眼部炎症，且无全身不良反应，这3例患者均患有与溃疡性结肠炎相关的前葡萄膜炎。在7例患者中的6例中，全身使用非甾体抗炎药被证明是有益的，另有1例患者受益于另一种抗炎药（硫酸羟氯喹）。其余7例患者使用了全身细胞毒性免疫抑制疗法，其中6例患有双侧疾病。这些患者中有6例的眼部炎症得到了控制。硫唑嘌呤对巩膜炎有益，但对前葡萄膜炎效果较差，尤其是在克罗恩病中，因此需要使用另一种细胞毒性药物。HLA - B27阳性的前葡萄膜炎对皮质类固醇治疗更具难治性，更有可能需要全身细胞毒性免疫抑制疗法。采用所述的药物和手术策略，研究组中的所有患者视力均得到改善或维持。
