Karma A, Stenborg T, Summanen P, Immonen I, Mikkilä H, Seppälä I
Department of Ophthalmology, University of Helsinki, Finland.
Retina. 1996;16(6):505-9. doi: 10.1097/00006982-199616060-00006.
The authors report sequential fluorescein angiographic and color photographic findings of the fundi and response to treatment in a patient with chronic Lyme neuroretinitis.
A Lyme enzyme-linked immunosorbent assay with purified 41-kd flagellin as antigen was used to detect immunoglobulin G and immunoglobulin M antibodies to Borrelia burgdorferi in serum, cerebrospinal fluid, and vitreous. The changes were documented by fluorescein angiography and color photography tests performed during a 5 1/2 year follow-up.
The diagnosis of Lyme neuroretinitis was based on the history of erythema migrans and positive Lyme enzyme-linked immunosorbent assay tests from cerebrospinal fluid and vitreous and by the exclusion of other infectious and systemic diseases and uveitis entities. Fluorescein angiography results disclosed bilateral chronic neuroretinal edema with areas of cystoid, patchy, and diffuse hyperfluorescence peripapillary and in the macular areas. The hyperfluorescent lesions enlarged despite a 9-month period of antibiotic therapy.
Lyme borreliosis may cause neuroretinitis with unusual angiographic findings. Chronic Lyme neuroretinitis may be unresponsive to antibiotic therapy.
作者报告了一例慢性莱姆病性神经视网膜炎患者眼底的系列荧光素血管造影和彩色摄影结果以及对治疗的反应。
采用以纯化的41-kd鞭毛蛋白为抗原的莱姆病酶联免疫吸附试验，检测血清、脑脊液和玻璃体内抗伯氏疏螺旋体的免疫球蛋白G和免疫球蛋白M抗体。在5年半的随访期间，通过荧光素血管造影和彩色摄影检查记录变化情况。
莱姆病性神经视网膜炎的诊断基于游走性红斑病史、脑脊液和玻璃体内莱姆病酶联免疫吸附试验结果阳性，以及排除其他感染性和全身性疾病及葡萄膜炎类型。荧光素血管造影结果显示双侧慢性神经视网膜水肿，视乳头周围和黄斑区有囊样、斑片状和弥漫性高荧光区。尽管进行了9个月的抗生素治疗，高荧光病变仍扩大。
莱姆病可能导致具有不寻常血管造影表现的神经视网膜炎。慢性莱姆病性神经视网膜炎可能对抗生素治疗无反应。
