Rothova A, Lardenoye C
Department of Ophthalmology, FC Donders Institute, Academic Hospital Utrecht, The Netherlands.
Ophthalmology. 1998 Aug;105(8):1393-7. doi: 10.1016/S0161-6420(98)98018-6.
This study aimed to describe the clinical presentation, angiographic findings, and natural history of acquired arterial macroaneurysms diagnosed in 8 of 48 patients with peripheral multifocal chorioretinitis (PMC) (panuveitis with multiple peripheral punched-out chorioretinal lesions).
A retrospective case-control study.
Forty-eight consecutive patients with PMC, consisting of 13 patients with histologically or radiologically proven sarcoidosis, 11 with laboratory evidence of (presumed) sarcoidosis, and 24 with no evidence of systemic disease, participated in the study.
A review of the clinical, photographic, and angiographic records was performed.
Arterial macroaneurysms, clinical symptoms, and associations with systemic disease were measured.
Of 48 patients with PMC, 8 (17%) had arterial macroaneurysms: 3 (38%) of 8 with histologically proven sarcoidosis, 1 (20%) of 5 with radiologically proven sarcoidosis, 2 (18%) of 11 with laboratory evidence of sarcoidosis, and 2 (8%) of 24 patients with no evidence of systemic sarcoidosis. All eight patients were white females older than 60 years of age. Macroaneurysms appeared to be unrelated to the systemic hypertension (5 of 17 compared to 3 of 31; P = 0.11); however, the frequency of cerebrovascular accidents or myocardial infarctions was higher among those with macroaneurysms (5 of 8 vs. 2 of 40; P = 0.0000). Three of the eight patients reported visual complaints related to macroaneurysms; only one patient required laser treatment. Fluorescein angiography showed no evidence of previous vasculitis in the involved area.
Arterial macroaneurysms, which occur in elderly female patients with PMC, are associated with severe cardiovascular disease. Whether the macroaneurysms are a complication of an inflammatory vascular process remains speculative.
本研究旨在描述48例周边多灶性脉络膜视网膜炎（PMC，伴有多个周边凿孔状脉络膜视网膜病变的全葡萄膜炎）患者中8例确诊的后天性动脉大动脉瘤的临床表现、血管造影结果及自然病程。
一项回顾性病例对照研究。
48例连续的PMC患者，其中13例经组织学或放射学证实为结节病，11例有（推测的）结节病实验室证据，24例无全身疾病证据，参与了本研究。
对临床、照片及血管造影记录进行回顾。
测量动脉大动脉瘤、临床症状及与全身疾病的关联。
48例PMC患者中，8例（17%）有动脉大动脉瘤：8例经组织学证实为结节病的患者中有3例（38%），5例经放射学证实为结节病的患者中有1例（20%），11例有结节病实验室证据的患者中有2例（18%），24例无全身结节病证据的患者中有2例（8%）。所有8例患者均为60岁以上的白人女性。大动脉瘤似乎与系统性高血压无关（17例中有5例，而31例中有3例；P = 0.11）；然而，有大动脉瘤的患者中脑血管意外或心肌梗死的发生率更高（8例中有5例，而40例中有2例；P = 0.0000）。8例患者中有3例报告了与大动脉瘤相关的视觉症状；只有1例患者需要激光治疗。荧光素血管造影显示受累区域无既往血管炎证据。
发生于老年女性PMC患者的动脉大动脉瘤与严重心血管疾病相关。大动脉瘤是否为炎症性血管过程的并发症仍存在推测。
