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[弓形虫性脉络膜视网膜炎并发视网膜脱离]

[Toxoplasmic chorioretinitis complicated by retinal detachment].

作者信息

Frau E, Gregoire-Cassoux N, Lautier-Frau M, Labetoulle M, Lehoang P, Offret H

机构信息

Service d'Ophtalmologie, CHU de Bicêtre, Le Kremlin-Bicêtre.

出版信息

J Fr Ophtalmol. 1997;20(10):749-52.

PMID:9587588
Abstract

PURPOSE

To describe and analyse relationship between chorioretinal toxoplasmosis and retinal detachment.

PATIENTS AND METHODS

Seven immunocompetent patients examined and treated between November 1992 and March 1996, with ocular toxoplasmic retinochoroiditis and retinal detachment.

RESULTS

Of the 7 patients examined, 5 had active retinochoroiditis and 2 had typical inactive scars. Of the patients with active focus 3 had giant retinal tears, one had a posterior retinal tear and one had a retinal tear located at the edge of an atrophic scar. Of the patients with inactive lesions, one had tractional retinal detachment and the other presented with a complete retinal detachment, multiples tears and PVR. Five patients were treated by corticosteroid without antitoxoplasmic drug before they were referred. The seven patients underwent endo-ocular surgery with silicon oil or long actic gas tamponade. Three patients developed PVR and redetachment of the retina and two patients underwent further surgery. Good anatomical result was obtained in 6 patients.

CONCLUSION

Retinal detachment associated with toxoplasmic retinochoroiditis is rare. However it represents a serious complication. Steroid administrated to salvage vision may then worsen the clinical course, these may be justified to reduce hypersensitivity to toxoplasma antigen, but they should be combined with an antimicrobial agent.

摘要

目的

描述并分析脉络膜视网膜弓形体病与视网膜脱离之间的关系。

患者与方法

1992年11月至1996年3月期间对7例免疫功能正常的患者进行了检查和治疗,这些患者患有眼部弓形体性视网膜脉络膜炎和视网膜脱离。

结果

在接受检查的7例患者中,5例有活动性视网膜脉络膜炎,2例有典型的非活动性瘢痕。在有活动性病灶的患者中,3例有巨大视网膜裂孔,1例有视网膜后裂孔,1例有位于萎缩性瘢痕边缘的视网膜裂孔。在有非活动性病变的患者中,1例有牵拉性视网膜脱离,另1例表现为完全性视网膜脱离、多发性裂孔和增殖性玻璃体视网膜病变(PVR)。5例患者在转诊前接受了皮质类固醇治疗,但未使用抗弓形体药物。7例患者接受了眼内手术,采用硅油或长效气体填塞。3例患者发生了PVR和视网膜再脱离,2例患者接受了进一步手术。6例患者获得了良好的解剖学结果。

结论

与弓形体性视网膜脉络膜炎相关的视网膜脱离很少见。然而,它是一种严重的并发症。为挽救视力而使用的类固醇可能会使临床病程恶化,使用类固醇可能有理由降低对弓形体抗原的超敏反应,但应与抗菌药物联合使用。

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