Schwartz G S, Harrison A R, Holland E J
Department of Ophthalmology, University of Minnesota, Minneapolis, USA.
Cornea. 1998 May;17(3):278-81.
We compared the etiologies of immune stromal keratitis (ISK), also known as interstitial keratitis (IK), in a recent group of patients with active and inactive ISK.
We reviewed the charts of 97 patients seen in the cornea clinic at the University of Minnesota from 1985 through 1994. Fifty-five patients were classified as having active ISK, defined by stromal inflammation without ulceration within 1 year of presentation. Forty-two patients were identified as having inactive ISK, defined by evidence of past stromal inflammation including stromal scarring, stromal thinning, ghost vessels, and reduplication of Descemet's membrane without active inflammation for the 1 year before presentation. We determined the etiology of the ISK by careful review of the patient's ocular examination, as well as medical and laboratory workup. Patients were labeled with the diagnosis of idiopathic ISK if no identifiable etiology was found.
Herpes simplex virus (HSV) accounted for 71.4% of unilateral active ISK. Idiopathic accounted for 14.3%, and varicella-zoster virus accounted for 8.6% in this group. HSV was the etiologic factor of 50.0% of inactive unilateral cases, whereas 33.3% were idiopathic. Sixty percent of cases of bilateral, active ISK were from idiopathic causes. Syphilis was the cause of 48.5% of bilateral inactive cases. In this group, 33.3% were from idiopathic causes.
Although syphilis has been recognized for many years as the cause of 90% of cases of ISK, this is no longer true. We demonstrated that active ISK is most commonly caused by HSV or is idiopathic and that, although syphilis is the leading cause of inactive, bilateral ISK, it is responsible for only 18.6% of total cases.
我们比较了近期一组活动性和非活动性免疫性基质性角膜炎（ISK，也称为间质性角膜炎[IK]）患者的病因。
我们回顾了1985年至1994年在明尼苏达大学角膜门诊就诊的97例患者的病历。55例患者被归类为患有活动性ISK，定义为就诊后1年内出现基质炎症但无溃疡。42例患者被确定为患有非活动性ISK，定义为有既往基质炎症的证据，包括基质瘢痕、基质变薄、血管翳和后弹力层重复，就诊前1年无活动性炎症。我们通过仔细检查患者的眼部情况以及医学和实验室检查来确定ISK的病因。如果未发现可识别的病因，则将患者诊断为特发性ISK。
单纯疱疹病毒（HSV）占单侧活动性ISK的71.4%。特发性占14.3%，水痘带状疱疹病毒占8.6%。HSV是50.0%的非活动性单侧病例的病因，而33.3%为特发性。60%的双侧活动性ISK病例病因不明。梅毒是48.5%的双侧非活动性病例的病因。在这组病例中，33.3%病因不明。
尽管多年来一直认为梅毒是90%的ISK病例的病因，但现在情况已非如此。我们证明活动性ISK最常见的病因是HSV或病因不明，并且尽管梅毒是非活动性双侧ISK的主要病因，但它仅占总病例数的18.6%。
