摘要
目的 探讨及分析急性视网膜坏死综合征的临床资料，评估临床综合治疗的效果。方法 回顾性分析。2019年1月至2021年12月于重庆爱尔眼科医院和达州市中心医院确诊，并治疗的急性视网膜坏死综合征（ARNS）患者16例（16眼）纳入研究。所有患者均抽取玻璃体液行PCR检测。16眼行均行玻璃体腔注药术（更昔洛韦），平均给药次数2.78±1.62。12眼患者行玻璃体切除术+硅油填充术+玻璃体腔注药术（更昔洛韦），并于术中行视网膜光凝术。术后随访4-12个月，观察视力、眼压、眼部病情变化、视网膜脱离发生情况。结果 所有患者随访期间未出现视网膜脱离、视神经萎缩、增殖性玻璃体视网膜病变等并发症，对侧眼均未发生ARNs。治疗前及治疗后患者的最佳矫正视力（BCVA）有着不同程度提高。结论 急性视网膜坏死患者病原学以VZV为主，或合并EBV。全身联合局部抗病毒并辅以激素的综合治疗可有效遏制急性视网膜坏死综合征的病程进展，一定程度上维持和改善现存视力。在此基础上，玻璃体视网膜手术及硅油填充可以明显减少ARNs患者视力严重下降的发生率，预防并发症的产生，有效挽救患者的视力。
关键词： 急性视网膜坏死；PCR；更昔洛韦
Abstract
Objective: To investigate and analyze the clinical data of acute retinal necrosis syndrome (ARNS) and evaluate the effect of clinical comprehensive treatment. Methods: 16 eyes were treated with intravitreal injection of ganciclovir, with an average dose of 2.78 ± 1.62. 12 eyes underwent vitrectomy+silicone oil tamponade+intravitreal injection (ganciclovir) and retinal photocoagulation during the operation. The patients were followed up for 4-12 months to observe the visual acuity, intraocular pressure, eye condition changes and retinal detachment. Results: No complications such as retinal detachment, optic atrophy, proliferativevitreoretinopathy occurred in all patients during the follow-up period, and no ARNs occurred in the contralateral eyes. The best corrected visual acuity (BCVA) of patients before and after treatment was improved to varying degrees. Conclusion : The etiology of ARN is mainly VZV or EBV. Combined systemic and local antiviral therapy combined with hormone therapy can effectively curb the progression of acute retinal necrosis syndrome, and maintain and improve the existing vision to a certain extent. On this basis, vitreoretinal surgery and silicone oil filling can significantly reduce the incidence of severe vision decline in ARNs patients, prevent complications, and effectively save the vision of patients.
Key words： Acute retinal necrosis; PCR; Ganciclovir
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