George R K, Walton R C, Whitcup S M, Nussenblatt R B
Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, USA.
Ophthalmology. 1996 Mar;103(3):384-9. doi: 10.1016/s0161-6420(96)30681-7.
Inflammation of the retinal vasculature without an infectious etiology, systemic disease association, or concomitant ocular disease is termed primary retinal vasculitis, and can result in severe and permanent vision loss. Patients with primary retinal vasculitis usually are subjected to an extensive but unrewarding diagnostic evaluation. This study was undertaken to determine the value of such a diagnostic workup, and to determine whether systemic diseases develop in these patients during the course of their illness.
The clinical records of 25 patients seen between 1984 and 1994 with the referring diagnosis of primary retinal vasculitis were reviewed retrospectively. Recorded data included patient age, sex, race, medical history, medications, visual acuity, extent of retinal disease, and the results of their diagnostic evaluations.
On presentation, none of the patients had an underlying systemic disease attributable as the cause of their retinal vasculitis. Review of systems was suggestive of an underlying systemic disease in 1 of 25 patients. Diagnostic evaluation in this patient showed a positive antinuclear antibody value and a double-stranded DNA, suggestive of systemic lupus erythematosus. Subsequently, systemic lupus erythematosus was diagnosed based on the development of other diagnostic criteria. The review of systems was not suggestive of an underlying systemic disease in 24 of 25 patients. False-positive diagnostic test results were obtained in 5 (20.8%) of these 24 patients. No underlying systemic disease associated with the patients' retinal vasculitis subsequently developed in any of these five patients (mean follow-up, 4 years).
Few diagnostic tests should be ordered in patients with retinal vasculitis in the absence of a medical history suggestive of underlying systemic disease.
视网膜血管炎若没有感染病因、全身疾病关联或伴发眼部疾病，则被称为原发性视网膜血管炎，可导致严重且永久性视力丧失。原发性视网膜血管炎患者通常要接受广泛但并无收获的诊断评估。本研究旨在确定此类诊断检查的价值，并确定这些患者在病程中是否会出现全身性疾病。
回顾性分析1984年至1994年间就诊的25例诊断为原发性视网膜血管炎患者的临床记录。记录的数据包括患者年龄、性别、种族、病史、用药情况、视力、视网膜疾病范围以及诊断评估结果。
初诊时，所有患者均无潜在全身性疾病可归因于其视网膜血管炎的病因。系统回顾提示25例患者中有1例存在潜在全身性疾病。该患者的诊断评估显示抗核抗体值和双链DNA呈阳性，提示系统性红斑狼疮。随后，根据其他诊断标准确诊为系统性红斑狼疮。25例患者中有24例的系统回顾未提示存在潜在全身性疾病。这24例患者中有5例（20.8%）获得了假阳性诊断试验结果。这5例患者中随后均未出现与视网膜血管炎相关的潜在全身性疾病（平均随访4年）。
对于无提示潜在全身性疾病病史的视网膜血管炎患者，应少做诊断性检查。
