Malinowski S M, Pulido J S, Folk J C
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City.
Ophthalmology. 1993 Jun;100(6):818-24; discussion 825. doi: 10.1016/s0161-6420(93)31567-8.
To identify the ocular complications and to statistically evaluate the possible association of pars planitis with multiple sclerosis (MS) in a homogeneous population of pars planitis patients.
The authors reexamined 36 patients and reviewed the records of an additional 18 patients (total: 54 patients, 108 eyes) with idiopathic pars planitis.
The initial mean visual acuity of 20/46 (logMAR: 0.36 +/- 0.50) was not statistically different from the final mean visual acuity of 20/44 (logMAR: 0.34 +/- 0.45; P = 0.73), after a mean follow-up of 89.2 months. Complications included neovascularization with or without associated vitreous hemorrhage (7 eyes, 6.5%), moderate to severe cellophane retinopathy (7 eyes, 6.5%), chronic cystoid macular edema (CME) (9 eyes, 8.3%), visually significant cataracts (16 eyes, 14.8%), and retinal detachment (9 eyes, 8.3%). Significant lens opacification was associated with a greater risk of retinal detachment (P = 0.004). In four patients (7.4%), optic neuritis developed, and in an additional eight patients (14.8%) MS developed. Kaplan-Meier analysis of these data showed a 16.2% +/- 6.2% risk of MS solely developing in patients, and a 20.4% +/- 6.7% risk of either MS or optic neuritis developing, after 5 years of disease. The presence of periphlebitis at the time of pars planitis diagnosis increased the rate of development of these conditions (P = 0.002). Six patients (11.1%) had a family history positive for MS in a first-degree relative.
This study demonstrates the overall favorable visual prognosis in patients with pars planitis. Patients with significant cataract formation appear to be at greater risk for retinal detachment. Periphlebitis at the time of diagnosis of pars planitis increases the risk of development of optic neuritis or MS. The strong association demonstrated between pars planitis and MS in this study further supports a link between the two disease states.
在一组同质的中间葡萄膜炎患者中，确定眼部并发症，并对中间葡萄膜炎与多发性硬化症（MS）之间可能的关联进行统计学评估。
作者对36例患者进行了复查，并回顾了另外18例特发性中间葡萄膜炎患者的病历（共54例患者，108只眼）。
平均随访89.2个月后，初始平均视力20/46（logMAR：0.36±0.50）与最终平均视力20/44（logMAR：0.34±0.45；P = 0.73）无统计学差异。并发症包括伴或不伴玻璃体出血的新生血管形成（7只眼，6.5%）、中度至重度玻璃纸样视网膜病变（7只眼，6.5%）、慢性黄斑囊样水肿（CME）（9只眼，8.3%）、具有视觉意义的白内障（16只眼，14.8%）和视网膜脱离（9只眼，8.3%）。明显的晶状体混浊与视网膜脱离风险增加相关（P = 0.004）。4例患者（7.4%）发生视神经炎，另外8例患者（14.8%）发生MS。对这些数据进行Kaplan-Meier分析显示，疾病发生5年后，患者单独发生MS的风险为16.2%±6.2%，发生MS或视神经炎的风险为20.4%±6.7%。中间葡萄膜炎诊断时存在静脉周围炎会增加这些疾病的发生率（P = 0.002）。6例患者（11.1%）的一级亲属中有MS家族史阳性。
本研究表明中间葡萄膜炎患者总体视力预后良好。有明显白内障形成的患者似乎发生视网膜脱离的风险更高。中间葡萄膜炎诊断时的静脉周围炎会增加视神经炎或MS发生的风险。本研究中中间葡萄膜炎与MS之间显示的强关联进一步支持了这两种疾病状态之间的联系。
