葡萄膜炎:病因、临床表现和诊断
- Author
- James T Rosenbaum, MD
James T Rosenbaum, MD
- Professor of Ophthalmology, Medicine, and Cell Biology
- Oregon Health & Science University
- Chief of Ophthalmology
- Devers Eye Institute, Portland, Oregon
- Section Editor
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
- Deputy Editor
- Paul L Romain, MD
Paul L Romain, MD
- Deputy Editor — Rheumatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
引言
葡萄膜炎是一种眼内炎症病程,可由多种病因引起。大多数提示有葡萄膜炎症的患者需要转诊到眼科专科医生处。
本专题主要介绍葡萄膜炎及其亚类的定义、其与全身性疾病的鉴别诊断,以及非眼科医生在葡萄膜炎患者的诊断性评估中的作用。
葡萄膜炎的治疗参见其他专题。 (参见“葡萄膜炎的治疗”)
定义
葡萄膜为眼球的中层。这一术语源于“葡萄”的拉丁语,因为解剖学家曾认为在剥去眼球外层后,其下方结构状如葡萄。葡萄膜前部包括虹膜和睫状体,后部称为脉络膜(图 1)。
●前葡萄膜的炎症称为前葡萄膜炎,与虹膜炎同义。炎症累及相邻的睫状体时,这一病程就称为虹膜睫状体炎[1]。
Subscribers log in here
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2017-02-24.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005; 140:509.
- Wertheim MS, Mathers WD, Planck SJ, et al. In vivo confocal microscopy of keratic precipitates. Arch Ophthalmol 2004; 122:1773.
- Yeh S, Forooghian F, Suhler EB. Implications of the Pacific Ocular Inflammation uveitis epidemiology study. JAMA 2014; 311:1912.
- Weiss MJ, Velazquez N, Hofeldt AJ. Serologic tests in the diagnosis of presumed toxoplasmic retinochoroiditis. Am J Ophthalmol 1990; 109:407.
- Bosch-Driessen LE, Berendschot TT, Ongkosuwito JV, Rothova A. Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology 2002; 109:869.
- Margo CE, Hamed LM. Ocular syphilis. Surv Ophthalmol 1992; 37:203.
- Suhler EB, Lauer AK, Rosenbaum JT. Prevalence of serologic evidence of cat scratch disease in patients with neuroretinitis. Ophthalmology 2000; 107:871.
- Rosenbaum JT. Acute anterior uveitis and spondyloarthropathies. Rheum Dis Clin North Am 1992; 18:143.
- Haroon M, O'Rourke M, Ramasamy P, et al. A novel evidence-based detection of undiagnosed spondyloarthritis in patients presenting with acute anterior uveitis: the DUET (Dublin Uveitis Evaluation Tool). Ann Rheum Dis 2015; 74:1990.
- Muñoz-Fernández S, de Miguel E, Cobo-Ibáñez T, et al. Enthesis inflammation in recurrent acute anterior uveitis without spondylarthritis. Arthritis Rheum 2009; 60:1985.
- Lambert JR, Wright V. Eye inflammation in psoriatic arthritis. Ann Rheum Dis 1976; 35:354.
- Lyons JL, Rosenbaum JT. Uveitis associated with inflammatory bowel disease compared with uveitis associated with spondyloarthropathy. Arch Ophthalmol 1997; 115:61.
- Paiva ES, Macaluso DC, Edwards A, Rosenbaum JT. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis 2000; 59:67.
- Rosenbaum JT. Uveitis. An internist's view. Arch Intern Med 1989; 149:1173.
- Henderly DE, Genstler AJ, Smith RE, Rao NA. Changing patterns of uveitis. Am J Ophthalmol 1987; 103:131.
- Rothova A, Buitenhuis HJ, Meenken C, et al. Uveitis and systemic disease. Br J Ophthalmol 1992; 76:137.
- Obenauf CD, Shaw HE, Sydnor CF, Klintworth GK. Sarcoidosis and its ophthalmic manifestations. Am J Ophthalmol 1978; 86:648.
- James DG. Ocular sarcoidosis. Ann N Y Acad Sci 1986; 465:551.
- Karma A, Huhti E, Poukkula A. Course and outcome of ocular sarcoidosis. Am J Ophthalmol 1988; 106:467.
- Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. Lancet 1990; 335:1078.
- Mamo JG. The rate of visual loss in Behçet's disease. Arch Ophthalmol 1970; 84:451.
- Rosenbaum JT, Bennett RM. Chronic anterior and posterior uveitis and primary Sjögren's syndrome. Am J Ophthalmol 1987; 104:346.
- Gold DH, Morris DA, Henkind P. Ocular findings in systemic lupus erythematosus. Br J Ophthalmol 1972; 56:800.
- Stafford-Brady FJ, Urowitz MB, Gladman DD, Easterbrook M. Lupus retinopathy. Patterns, associations, and prognosis. Arthritis Rheum 1988; 31:1105.
- Rosenbaum JT, Roman-Goldstein S, Lindquist GR, Rosenbaum RB. Uveitis and central nervous system vasculitis. J Rheumatol 1998; 25:593.
- Rubsamen PE, Gass JD. Vogt-Koyanagi-Harada syndrome. Clinical course, therapy, and long-term visual outcome. Arch Ophthalmol 1991; 109:682.
- Zhang XY, Wang XM, Hu TS. Profiling human leukocyte antigens in Vogt-Koyanagi-Harada syndrome. Am J Ophthalmol 1992; 113:567.
- Malinowski SM, Pulido JS, Folk JC. Long-term visual outcome and complications associated with pars planitis. Ophthalmology 1993; 100:818.
- Zein G, Berta A, Foster CS. Multiple sclerosis-associated uveitis. Ocul Immunol Inflamm 2004; 12:137.
- Bregerbc, Leopold IH. The incidence of uveitis in multiple sclerosis. Am J Ophthalmol 1966; 62:540.
- Prieto JF, Dios E, Gutierrez JM, et al. Pars planitis: epidemiology, treatment, and association with multiple sclerosis. Ocul Immunol Inflamm 2001; 9:93.
- Lubin JR, Albert DM, Weinstein M. Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913--1978). Ophthalmology 1980; 87:109.
- Priem HA, Oosterhuis JA. Birdshot chorioretinopathy: clinical characteristics and evolution. Br J Ophthalmol 1988; 72:646.
- LeHoang P, Ozdemir N, Benhamou A, et al. HLA-A29.2 subtype associated with birdshot retinochoroidopathy. Am J Ophthalmol 1992; 113:33.
- Shafran SD, Deschênes J, Miller M, et al. Uveitis and pseudojaundice during a regimen of clarithromycin, rifabutin, and ethambutol. MAC Study Group of the Canadian HIV Trials Network. N Engl J Med 1994; 330:438.
- Ambati J, Wynne KB, Angerame MC, Robinson MR. Anterior uveitis associated with intravenous cidofovir use in patients with cytomegalovirus retinitis. Br J Ophthalmol 1999; 83:1153.
- Bainbridge JW, Raina J, Shah SM, et al. Ocular complications of intravenous cidofovir for cytomegalovirus retinitis in patients with AIDS. Eye (Lond) 1999; 13 ( Pt 3a):353.
- Wefers Bettink-Remeijer M, Brouwers K, van Langenhove L, et al. Uveitis-like syndrome and iris transillumination after the use of oral moxifloxacin. Eye (Lond) 2009; 23:2260.
- Malinowski SM, Pulido JS, Goeken NE, et al. The association of HLA-B8, B51, DR2, and multiple sclerosis in pars planitis. Ophthalmology 1993; 100:1199.
- DARRELL RW, WAGENER HP, KURLAND LT. Epidemiology of uveitis. Incidence and prevalence in a small urban community. Arch Ophthalmol 1962; 68:502.
- Kanda T, Shibata M, Taguchi M, et al. Prevalence and aetiology of ocular hypertension in acute and chronic uveitis. Br J Ophthalmol 2014; 98:932.
- Jabs DA, Busingye J. Approach to the diagnosis of the uveitides. Am J Ophthalmol 2013; 156:228.
- Lou SM, Larkin KL, Winthrop K, et al. Lack of consensus in the diagnosis and treatment for ocular tuberculosis among uveitis specialists. Ocul Immunol Inflamm 2015; 23:25.
- Forooghian F, Gupta R, Wong DT, Derzko-Dzulynsky L. Anterior uveitis investigation by Canadian ophthalmologists: insights from the Canadian National Uveitis Survey. Can J Ophthalmol 2006; 41:576.
- Guly CM, Forrester JV. Investigation and management of uveitis. BMJ 2010; 341:c4976.
- Rosenbaum JT, Wernick R. The utility of routine screening of patients with uveitis for systemic lupus erythematosus or tuberculosis. A Bayesian analysis. Arch Ophthalmol 1990; 108:1291.
- Rosenbaum JT, Rahn DW. Prevalence of Lyme disease among patients with uveitis. Am J Ophthalmol 1991; 112:462.
- Hong BK, Khanamiri HN, Bababeygy SR, Rao NA. The utility of routine tuberculosis screening in county hospital patients with uveitis. Br J Ophthalmol 2014; 98:1091.
- Ang M, Wong W, Ngan CC, Chee SP. Interferon-gamma release assay as a diagnostic test for tuberculosis-associated uveitis. Eye (Lond) 2012; 26:658.
- Kaiser PK, Lowder CY, Sullivan P, et al. Chest computerized tomography in the evaluation of uveitis in elderly women. Am J Ophthalmol 2002; 133:499.
- Harper TW, Miller D, Schiffman JC, Davis JL. Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. Am J Ophthalmol 2009; 147:140.
Top