摘要
目的 观察肺结核合并拟诊眼内结核患者的眼部表现特征.方法 对临床确诊为活动性肺结核的159例患者行视力、裂隙灯显微镜及间接检眼镜等全面眼科检查,对眼底可见视网膜脉络膜炎性浸润灶、视网膜出血、视网膜脱离等可疑病灶者同时行荧光素眼底血管造影（FFA）及光相干断层扫描（OCT）检查,判定其是否合并拟诊眼内结核.159例患者中,9例16只眼拟诊眼内结核,拟诊眼内结核检出率为5.67％.其中,男性5例,女性4例;年龄19～64岁,平均年龄35.12岁.双眼发病7例,单眼发病2例.葡萄膜炎8例15只眼,占患眼的93.75％;视网膜中央静脉阻塞（CRVO）1例1只眼,占患眼的6.25％.所有拟诊眼内结核患者血清快速梅毒螺旋体血凝试验、人类免疫缺陷病毒抗体检测均为阴性;弓形虫抗体滴度正常范围;CRVO患者血脂、血糖、血液流变检查未见异常.观察拟诊眼内结核患眼的眼部表现特征.结果 16只拟诊眼内结核眼中,矫正视力为光感～0.15者6只眼,均为全葡萄膜炎者;矫正视力为0.8～1.0者10只眼.眼前节改变10只眼,其中肉芽肿性葡萄膜炎8只眼,非肉芽肿性葡萄膜炎2只眼.肉芽肿性葡萄膜炎患眼表现为虹膜结节、虹膜后粘连及羊脂状角膜后沉着（KP）;非肉芽肿性葡萄膜炎患眼表现为KP、无虹膜结节和虹膜后粘连.脉络膜结节7只眼,其眼底可见3～7个1/4～1/2视盘直径大小不等、灰白色且边界不清楚的病灶,伴局部视网膜浅脱离;FFA检查表现为动脉期、动静脉期病灶呈边界不清楚的弱荧光区,后期病灶区荧光逐渐增强,晚期病灶呈边界不清楚的强荧光、荧光素积存;OCT检查可见病灶处视网膜色素上皮液性隆起.CRVO1只眼,眼底表现为点、片、线状出血,部分出血灶中心可见白色病灶.结论 拟诊眼内结核患眼主要表现为眼前节肉芽肿性炎症改变和多发性脉络膜结节,也可单纯表现为CRVO.
Objective To observe the ocular manifestations of presumed ocular tuberculosis in patients with pulmonary tuberculosis.Methods One hundred and fifty nine patients with pulmonary tuberculosis received examinations of visual acuity,slit lamp microscopy and indirect ophthalmoscopy.Those patients with retinochoroidal inflammatory lesions,retinal hemorrhages or detachments underwent fundus fluorescein angiography （FFA） and optical coherence tomography （OCT） to determine whether the presumed ocular tuberculosis was involved.There were 9 patients （16 eyes,5.67%） of presumed ocular tuberculosis,including 5 males and 4 females.The age was ranged from 19 to 64 years old,with an average of 35.12 years.Seven patients were affected bilaterally and 2 patients affected unilaterally.There were 8 patients （15eyes,93.75%） with uveitis and 1 patient （1 eye,6.25%） with central retinal vein occlusion （CRVO）.The blood laboratory tests were negative in all cases.Results The corrected vision was from light sensation to 0.15 in 6 uveitis eyes,0.8 to 1.0 in 10 eyes.The anterior segment change was found in 10 eyes,which including granulomatous uveitis （8 eyes） and non-granulomatous uveitis （2 eyes）.Granulomatous uveitis eyes had iris nodules,posterior synechia of the iris and mutton-fat keratic precipitates （KP）.Nongranulomatous uveitis eyes had KP only.Choroidal tubercles were found in 7 eyes in which 3-7 off-white lesions of varying sizes were found with local retinal detachment.FFA revealed hypo-fluorescence with obscure boundary in arterial phase and arterial and venous phase,and hyper-fluorescence with obscure boundary in later phase.OCT showed retinal pigment epithelium uplift.There was 1 eye with CRVO,which had punctate,splinter and linear hemorrhage,white lesions in some hemorrhagic focus.Conclusion The presumed ocular tuberculosis eyes showed mainly granulomatous inflammation and multiple choroid tubercles,and CRVO sometime.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2014年第5期477-479,共3页
Chinese Journal of Ocular Fundus Diseases
关键词
结核
眼/诊断
结核
肺/并发症
Tuberculosis,ocular/diagnosis
Tuberculosis,pulmonary/complications
