作者单位：116033 大连，大连市第三人民医院眼科

获得性梅毒的葡萄膜炎临床特征和治疗

刘新夏建平王树纲崔林

【摘要】目的分析获得性梅毒患者的葡萄膜炎(梅毒性葡萄膜炎)临床特征，观察其治疗效果。方法回顾性分析15例(22只眼)经临床及血清学检查确诊的梅毒性葡萄膜炎患者临床资料，确诊后均行驱梅治疗，并随诊观察6个月以上。结果15例(22只眼)患者中，男9例，女6例。发病年龄为(47.3±5.2)岁。7例患者为双眼发病，8例为单眼发病。病程2 d～1.5年，平均病程2.2±1.6月。患者均以视力下降或眼前黑影飘动等为主诉就诊。初诊平均视力0.15±0.21； 9例患者(14只眼,63.6%)表现为全葡萄膜炎，6例(8只眼，36.4%)表现为后葡萄膜炎、视神经视网膜炎。玻璃体均有尘状混浊，眼底检查视网膜色泽污浊灰暗，黄斑中心凹反射消失，13例(20只眼，90.9%)可见视盘充血或水肿，21只眼行眼底血管造影检查显示，所有患眼均有程度不等的斑驳状背景荧光增强改变，20只眼的视乳头有荧光素着染或渗漏，16只眼的视网膜静脉有荧光素渗漏，4只眼出现黄斑囊样水肿。经驱梅治疗半年后随访时，视力提高19只眼(86.4%)，所有患眼炎症消退。结论梅毒性葡萄膜炎是一种可以治愈的疾病，早期诊断、正规治疗后患者的预后较好。

【关键词】梅毒；葡萄膜炎；治疗

DOI:10.3969/g.issn.0253-9802.2015.07.008

通讯作者，刘新， E-mail:740846396@qq.com

Abstract【】ObjectiveTo analyze the clinical characteristics and observe the therapeutic effect of acquired syphilitic uveitis. MethodsThe clinical data of 15 patients with acquired syphilitic uveitis confirmed by clinical and serologic tests were retrospectively analyzed. After the diagnosis was confirmed, the patients were treated with systemic therapy of penicillin against syphilis and followed up for over 6 months. ResultsAmong 15 patients (22 eyes), 9 were male and 6 female. The age of onset ranged from 27 to 61 years old, with a mean age of 47.3±5.2 years old. Seven patients were bilaterally affected and 8 were unilateral. The duration of symptoms ranged from 2 days to 1.5 years with an average of 2.2±1.6 months. The patients were admitted due to complaints about visual acuity decline and floaters. Upon the first admission, the mean visual acuity was 0.15±0.21. Nine patients (14 eyes/63.6%) were characterized with panuveitis, and 6 cases (8 eyes/36.4%) had posterior uveitis and neuroretinitis. Vitreous opacity was noted in all cases. Fundus examination revealed that the retina became opaque and dark, and the loss of reflex in the fovea. Optic disc congestion and edema were observed in 13 patients (20 eyes/90.9%). Fundus fluorescein angiography (FFA) showed spot fluorescent enhancement of varying degree in all eyes. Staining or hyperfluorescence of optic disc was seen in 20 eyes, retinal venous leakage in 16 and cystoid macular edema in 4. Following systemic therapy of penicillin, the visual acuity was enhanced in 19 eyes (86.4%) and the inflammatory responses were alleviated in all eyes. ConclusionsAcquired syphilitic uveitis could be completely cured. Early diagnosis and effective treatment yield good clinical prognosis.

收稿日期：(2015-01-06)

Clinical characteristics and treatment of acquired syphilitic uveitisLiuXin,XiaJianping,WangShugang,CuiLin.DepartmentofOphthalmology，theThirdPeople’sHospitalofDalian，Dalian116033，China

Correspondingauthor,LiuXin,E-mail:740846396@qq.com

【Key words】Syphilis; Uveitis; Therapy

梅毒是由苍白密螺旋体感染所引起的一种慢性传染病，主要通过性接触和血液途径传播。如不治疗，疾病进展，最终可在全身任何一个重要脏器造成严重损害[1]。梅毒被称为“伟大的模仿者”，它的眼部表现多种多样，主要表现为角膜基质炎、前部葡萄膜炎、中间葡萄膜炎、全葡萄膜炎、脉络膜视网膜炎、视网膜炎、视网膜血管炎、视神经炎等，其中以葡萄膜炎最为多见。……