摘要
目的比较阿昔洛韦不同用药时机对急性视网膜坏死(ARN)远期视力及并发症的影响。方法回顾性分析18例18只眼出现视网膜脱离的ARN患者的临床资料。根据开始使用阿昔洛韦治疗的不同时间点,将患者分为A组(未早期治疗组,10只眼,发病2~6周开始使用阿昔洛韦)和B组(早期治疗组,8只眼,发病2周内开始使用阿昔洛韦)。18只眼最终均接受玻璃体切除+硅油填充术。比较2组患者手术前后的视力、术中视网膜坏死程度以及术后高眼压、复发性视网膜脱离和视神经萎缩等并发症的发生情况。结果术前视力B组明显优于A组(P=0.004)。术中观察A组10只眼视网膜水肿、漏斗状脱离,蜘蛛网样坏死波及近全周视网膜,甚至赤道部后方;B组8只眼视网膜脱离较局限,坏死灶多位于视网膜周边。术后2月,A组视网膜中央血管闭塞、视乳头色苍白;B组视网膜中周部小血管闭塞,视乳头色淡红。术后复发性视网膜脱离A组(30%,3/10)高于B组(0,0/8)(P=0.216)。2组眼压无显著性差异(P>0.05)。术后1年,2组患者视力均有提高,B组明显优于A组(P<0.01),且B组的视力提高值也明显高于A组(P<0.05)。结论 ARN早期(2周内)全身使用阿昔洛韦等抗病毒药物可明显改善患者远期视力,对减轻闭塞性视网膜中央血管病变和视神经萎缩也发挥关键作用。
Objective To compare the clinical outcomes of acute retinal necrosis（ARN）with different administration time of Acyclovir. Methods Eighteen patients（eighteen eyes）with retinal detachment（RD）secondary to ARN were included in this retrospective analysis. Patients were divided into two groups according to the Acyclovir administration time. Group A,with ten patients,were treated with Acyclovir between two to six weeks after disease onset. Group B with eight patients,were treated with Acyclovir within two weeks. All patients further underwent vitrectomy and silicone oil tamponade for retinal detachment. Patients were followed up for one year. Pre-and post-operative visual acuity（VA）,extent of retinal necrosis,level of IOP,rate of recurrent RD,and level of optic nerve atrophy were investigated in two groups. Results The preoperative VA in group B were better than that in group A（P=0.004）. During surgery,the edematous,spider-web like retina and funnel-shaped RD were observed in all cases in group A. The necrosis lesion might extended to posterior portion of retina.While patients in group B presented with localized RD,mild retinal necrosis and peripheral vascular occlusion. Two months after surgery,occlusive central retinal vasculopathy and optic nerve atrophy were observed in group A,which were absent in group B. The rate of recurrent RD in group A（30%,3/10）was higher than that in group B（0%,0/8）（P=0.216）. There was no significant difference in IOP between the two groups. One year after surgery,VA improved in both groups and more significantly in group B（P〈0.01）. Similar finding was found in visual recovery value（P〈0.05）. Conclusion Earlier systemic Acyclovir administration may result in better clinical outcome compared to late Acyclovir administration in patients with acute retinal necrosis.
出处
《福建医科大学学报》
北大核心
2017年第5期334-338,共5页
Journal of Fujian Medical University
