段仙梅 薛黎萍

[摘要]急性视网膜坏死综合征（ARN），又名桐泽型葡萄膜炎，其特征是重度葡萄膜炎伴有视网膜动脉炎，周边大量渗出，视网膜坏死，玻璃体高度混浊，后期出现视网膜裂孔及视网膜脱离。病因多为疱疹病毒（包括 HSV 和 HZV）感染所致。本病患者一般视力极差，严重者甚至致盲，且治疗困难，因此早期诊断及治疗非常重要。目前诊断主要依据临床表现及相关影像学及实验室检查，聚合酶链式反应检测对病原学的检出具有高度特异性及敏感性，对疾病的早期诊断及治疗具有重要意义。目前 ARN 的治疗方法主要以口服伐昔洛韦及玻璃体腔注药为主，预防性激光及玻璃体切割手术效果尚不明确。

[关键词]急性视网膜坏死综合征;聚合酶链式反应;伐昔洛韦;玻璃体腔注药

[中图分类号] R774.1 [文献标识码] A  [文章编号]2095-0616（2021）22-0056-05

Progress in treatment of acute retinal necrosis syndrome

DUAN  Xianmei1    XUE  Liping2

1. Department of Ophthalmology， Tonghai County People's Hospital， Yunnan， Tonghai 652700;2. Department of Ophthalmology， Second People's Hospital of Yunnan Province，Yunnan， Kunming 650000， China

[Abstract] Acute retinal necrosis syndrome （ARN）， also known as Kirisawa's uveitis， is characterized by severe uveitis accompanied by retinal arteritis， massive exudation， retinal necrosis， highly turbid vitreous， and retinal tears and retinal detachment in the later stage. The etiology is mostly herpes virus （including HSV and HZV） infection. Patients with this disease generally have poor eyesight， even blindness in severe cases， and it is difficult to treat， so the early diagnosis and treatment are of great importance. At present， the diagnosis is mainly based on clinical manifestations， related imaging and laboratory examination. Polymerase chain reaction detection is highly specific and sensitive to the detection of pathogens， which is of great significance to the early diagnosis and treatment of diseases. Currently， the main treatment methods of ARN are oral valaciclovir and intravitreal injection， but the effect of preventive laser and vitrectomy remains unclear.

[Key words] Acute retinal necrosis syndrome; Polymerase chain reaction; Valaciclovir; Intravitreal injection of drugs

急性视网膜坏死综合征（acute retinal necrosis syndrome， ARN）1971年由Urayama等首次报道，该病起病急，进展快，预后差，若治疗不及时，使患者失去最佳治疗时机，常导致患者严重的视力丧失[1]。如何及时发现，并早期治疗、挽救患者视力，引起眼科医师的广泛关注。目前 ARN 的治疗方法主要有抗病毒治疗、糖皮质激素治疗、抗血栓治疗、玻璃体腔注药治疗、视网膜激光光凝、玻璃体切割术等综合治疗[2]。本文将对近年来 ARN 诊治情况进行总结，以提高对本病的认识。

1概述

ARN 一般起病隐匿，临床过程可分为急性炎症期、缓解期和并發视网膜脱离期。急性炎症时出现单侧眼红、眼痛、眶周疼痛、眼部刺激感或异物感，早期出现视物模糊、眼前黑影，病变累及黄斑区时可造成视力严重下降。……