大剂量甲泼尼龙冲击治疗Vogt―小柳―原田病的效果观察.docVIP

大剂量甲泼尼龙冲击治疗Vogt—小柳一原 田病的效果观察 水肿消退，OCT示浆液性视网膜脱离消失，FFA荧光素渗漏 减轻。视力提高缓慢的32眼发病时间均^2周，用药2周视 力方缓慢提高。3眼治疗无效后改免疫抑制剂治疗。BCVA 转换为logMAR视力分析显示：与治疗前相比，治疗3d及 7 d后患眼视力明显改善，差异有高度统计学意义；与治疗3 d后相比，治疗7 d后视力亦明显提高，差异有高度统计学 意义。OCT变化情况分析显示：与治疗前相比，治疗3d及 7 d后平均黄斑中心凹区ILM-RPE视网膜厚度、黄斑部视网 膜容积以及黄斑部视网膜平均容积厚度均明显下降，差异有 高度统计学意义；与治疗3 d后相比，治疗7 d后平均黄斑 中心凹区ILM-RPE视网膜厚度、黄斑部视网膜容积以及黄 斑部视网膜平均容积厚度均明显下降，差异有高度统计学意 义。所有患者随访1年，未见严重不良反应，其中3例患者 于治疗后半年内复发，再次予以冲击治疗，随访稳定。结 论大剂量甲泼尼龙冲击治疗Vogt-小柳-原田病疗效确切、视 功能恢复快、复发率低、不良反应少，是一种安全有效的治 疗方法。且发病时间越短，治疗效果越好。 ［关键词］Vogt-小柳-原田病；甲泼尼龙；糖皮质激素 1673-721006-0134-04 [Abstract] Objective To observe the effect of high-dose Methylprednisolone treatment on Vogt-Koyanagi-Harada disease. Methods Sixty-nine hospitalized patients diagnosed with Vogt-Koyanagi-Harada disease from January 2013 to January 2016 in Xuhui District Central Hospital of Shanghai were analyzed retrospectively. All patients received high-dose Methylprednisolone treatment， with Methylprednisolone 1.0 g/d in early mornings for three consecutive days， and then the dosage was tapered based on the condition improvement. Before and after being treated for three and seven days， all patients underwent vision acuity examination， fundus examination, optical coherence tomography and fundus fluorescein angiography . The changes were analyzed， and the patients were followed up for one year. Results After treatment for one week， there were 100 eyes whose vision acuity were improved significantly [best corrected vision acuity 0.6], retina edema subsided， retinal detachment disappeared in OCT and fluorescence leakage reduced in FFA. All of the 32 eyes with vision acuity slowly improved were treated after an onset of no less than two weeks. The BCVA was improved slowly after treatment for two weeks. There were 3 eyes that showed no response to the high-dose methylprednisolone treatment and then received immunosuppressant therapy. Analysis of logMAR vision converted from BCVA， vision acuity of all patients was improved obviously after treatme