(精品) 葡萄膜炎课件

serpinginous choroiditis 匍行性脉络膜炎
Vogt-Koyanagi-Harada syndrome Vogt-小柳-原田综合征
又称特发性葡萄膜大脑炎
Bilateral granulomatous uveitis with blurred vision and systemic symptoms
• Laboratory Testing 实验室检查
Differential diagnosis鉴别诊断
• Acute conjunctivitis 急性结膜炎
– No decrease of vision – Bulbar and palpebral conjunctival congestion – Conjunctival discharge
Differential diagnosis鉴别诊断
• Acute Angle Closure Glaucoma 急性闭角性青光眼:
– Shallow anterior chamber 浅前房 – Pupil dialysis 瞳孔散大 – Elevated IOP 眼压高 – Use myotic eyedrop治疗时用缩瞳剂
– Anterior segment 眼前段：炎症复发或加剧
– Fundus 眼底：视乳头充血，后极部水肿，网脱
• sympathizing eye 交感眼
– Anterior segment眼前段：睫状或混合性充血
– Fundus 眼底：视乳头充血，网膜水肿，黄白色渗 出， Dalen-fuchs nodules，网脱，后期晚霞状眼底 sunset glow
– HLA-B27 associated • Ankylosing spondylitis • Reiter’s syndrome • Ulcerative colitis and Crohn disease • Psoriatic arthritis
– Behçet syndrome – Glaucomatocyclitic crisis (Posner-
Uveitis
Uveal Tract: iris, ciliary body and choroid
Uveal Tract
• Blood vessels • Pigment
Diseases of the Uveal Tract
• Inflammation (uveitis) • Tumors
临床表现
• Symptoms 症状
– pain疼痛 – photophobia畏光 – Blurred vision 视力减退
Signs体征
• Ciliary congestion 睫状充血 • KP • Tyndall phenomenon
充血
• 睫状充血或混合性充血
– ciliary injection or mixed injection
Treatment 治疗(1):
• Topic therapy 局部治疗:
– Cycloplegia-mydriasis 散瞳-首要措施
– 1)prevent or break posterior synechiae 防止或拉开后 粘连;
– 2)relieve ciliary spasm and pain 解除睫状肌痉挛;
• Prodroma前驱症状: headache，tinnitus耳鸣
• Ophthalmic changes ：bilateral
– Vogt-koyanagi syndrome小柳综合征：kp, tyndall
– Harada syndrome原田综合征：exudative retina detachmant 浆液性视网膜脱离 Late stage: sunset glow (晚霞状), DalenFuchus nodules
Etiology 病因:
• Autoimmune
– Hypersensitivity to pigment – retinal S antigen
• Infectious causal agents:
– Virus infection ?
Clinical manifestation
• exciting eye 诱发眼
Scholossman Syndrome) – Herpetic disease
• Chronic anterior uveitis
– Juvenile rheumatoid arthritis
– Fuchs heterochromic iridocyclits
Clinical Manifestations
Vogt-Koyanagi-Harada syndrome
Vogt-Koyanagi-Harada syndrome
1 week later after treatment
Vogt-Koyanagi-Harada syndrome sunset glow fundus
clinical manifestation 临床表现:
临床表现(体征）- occlusion of pupil
临床表现(体征）- iris bombe
Signs- iris nodules
– Koeppe nodules (at iris margin) – Busacca nodules (at iris stroma)
前段玻璃体混浊
Complications 并发症:
Classification of uveitis 葡萄膜炎分类：
– Etiology病因:
• infectious and non–infectious
– Duration 病程:
• acute and chronic
– Pathological manifestation病理形态:
• granulomatous and nongranulomatous
• Clinical manifestation临床表现 • -3 main symptoms症状
-3 main +2 minor signs体征:
– Ciliary congestion 睫状充血
– KP
– Tyndall
– Miosis 瞳孔缩小 – Iris posterior synechiae 虹膜后粘连
Differential diagnosis
• Intraocular tumor 眼内肿瘤:----masqurade syndrome 伪装综合症
– Retinoblastoma 视网膜母细胞瘤-前房积脓,眼内炎 – Melanoma 脉络膜黑色素瘤-色素，渗出物及肿瘤细胞
• Panuveitis 全葡萄膜炎：Behçet’s disease， Vogt-百度文库oyanagi-Harada syndrome (VKH) and so on
Uveitis
Uveitis
• Etiology and Pathogenesis 病因及发病机理 – Infectious 感染性:
• fungal, treponimal, bacterial, viral – exogenous 外源性：手术，外伤 – endogenous内源性
– Non-infectious 非感染性 • Auto-immune reactions自身免疫因素 • Oxidative stress damage 氧化损伤-细胞膜 脂，蛋白及核酸 • Immune-genetic mechanisms 免疫遗传机 制
• Circumcorneal redness
KP
• Keratic precipitates， KP （角膜后沉着物 ) – Dust KP 粉尘状 – Middle sized KP 中等大
– Mutton fat KP
羊脂状
Located inferior in Arlt’s triangle
• Prednisone：1mg/kg/d and tapering
– Non-steroids: Indoxole – Etiology 病因治疗
• For complications 并发症的治疗
– Glaucoma继发性青光眼 – cataract并发性白内障
Fuchs heterochromic iridocyclitis
• complications：macular cystoid edema, cataract
– 黄斑囊样水肿，白内障
OCT – macular cystoid edema
Posterior uveitis –choroditis 脉络膜炎
serpinginous choroiditis 匍行性脉络膜炎
KP
Tyndall Phenomenon (Tyn)
– aqueous flare 房水闪辉
房水细胞
– Hypopyon 前房积脓
临床表现(体征）
• Pupilary change – miosis – Synechia – Seclusion （闭 锁） – occlusion of pupil (膜闭） – iris bombe
Cycloplegic-mydritic agents药物:
– 1%-2% atropine 阿托品眼水或眼膏 – 2%homatropine后马托品
– Corticosteroids皮质类固醇：抑制炎症,减少 渗出
Treatment 治疗(2):
• Systemic therapy 全身治疗
– Corticosteroids皮质类固醇:
Glaucoma 青光眼
--Due to drainage defect
Complications 并发症:
• Cataract 并发性白内障
– Posterior capsular or cortical cataract
• Hypotony and phthisis 低眼压及眼 球萎缩
Diagnosis 诊断:
– Anatomic regions 解剖部位:
• Anterior • Intermediate • Posterior • pan
Anterior Uveitis
前葡萄膜炎
Common name for iritis虹膜炎and iridocyclitis虹膜睫状体炎
• Acute anterior uveitis
交感性眼炎
Bilateral granulomatous panuveitis occurs after injury of one eye (exciting eye), followed by a latent period and the development of the uveitis in the uninjured globe (the sympathizing eye). 眼穿通伤或内眼手术后，发生双侧肉芽肿 性葡萄膜炎
Systemic changes ：
headache， diziness眩晕， dysacousia听力减退， tinnitus耳 鸣，alopecia脱发，poliosis白发，vitiligo皮肤白癜风
Complications: cataract，Glaucoma and serous retina detachment
Treatment:
• Corticosteroids 皮质类固醇
– Systemic 全身(1mg/kg/d) – topic局部
• Immunosuppressants免疫抑制剂
– Cyclosporine 环孢霉素（5mg/kg/d）
• cycloplegia散瞳
Sympathetic Ophthalmia
Intermediate Uveitis (Pars Planitis)中间葡萄膜炎
• Young , 80% bilateral 多见 于青壮年，双眼
• Symptoms ：floaters视物糊 • Signs ：KP，aquous flare,
snowballs, snowbanks 房水 细胞，玻璃体雪球状混浊， 睫状体扁平部雪堤状渗出
双侧肉芽肿性全葡萄膜炎并累及全 身多个系统
Etiology:
• Asian or American Indian ancestry 有色人种多见 • Autoimmune : associated with HLA-DR4，
HLA-DRw53
clinical manifestation 临床表现: