十二章葡萄膜疾病课件.ppt

1、The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University第十二章葡萄膜疾病第十二章葡萄膜疾病UVEA DISEASES 1The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University一、概述一、概述o 葡萄膜由于

2、富含血管和色素组织故又称葡萄膜由于富含血管和色素组织故又称血管膜或色素膜。血管膜或色素膜。o 包括虹膜、睫状体、脉络膜，故病变相包括虹膜、睫状体、脉络膜，故病变相互影响。互影响。o 葡萄膜病是常见病，以炎症最为常见。葡萄膜病是常见病，以炎症最为常见。2The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University概述概述o 多发于青壮年，常合并糸统性自身免疫多发于青壮年，常合并糸统性自身免疫性疾病，病情反复

3、，常引起严重的并发性疾病，病情反复，常引起严重的并发症。症。o 病程：小于病程：小于3个月为急性个月为急性 大于大于3个月为慢性。个月为慢性。3The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo按解剖部位分类按解剖部位分类n 前葡萄炎前葡萄炎Anterior uveitisn 中间部葡萄炎中间部葡萄炎Intermediate uveitisn 后匍萄膜炎后匍萄膜炎Posterior uveit

4、isn 全葡萄膜炎全葡萄膜炎Generalized uveitis概述概述4The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University二、前葡萄膜炎二、前葡萄膜炎Anterior uveitiso概述概述：n 包括虹膜炎、虹膜睫状体炎和前部睫状体包括虹膜炎、虹膜睫状体炎和前部睫状体三种类型三种类型n 是最常见类型，占我国葡萄膜炎总数的是最常见类型，占我国葡萄膜炎总数的50%-60%n 病因：大多数为内源

5、性，例如细菌、病毒、病因：大多数为内源性，例如细菌、病毒、风湿性疾病等，其次与外伤及手术有关风湿性疾病等，其次与外伤及手术有关5The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University前葡萄膜炎前葡萄膜炎o症状：症状：n 刺激症状：眼痛、畏光、流泪、刺激症状：眼痛、畏光、流泪、视物模糊视物模糊n 视力下降视力下降6The second hospital of Medical college,Xian

6、Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo体症体症：n 睫状或混合性充血睫状或混合性充血n 角膜后沉着物角膜后沉着物KPn 房水闪辉房水闪辉Aqueous flaren 房水细胞房水细胞n 虹膜改变虹膜改变n 瞳孔改变瞳孔改变n 晶状体改变晶状体改变n 眼后段改变眼后段改变前葡萄膜炎前葡萄膜炎7The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medi

7、cal college,Xian Jiaotong Universityn 睫状或混合性充血睫状或混合性充血前葡萄膜炎前葡萄膜炎-体征体征8The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityn 角膜后沉着物角膜后沉着物o 定义：炎症细胞或色素沉积在角定义：炎症细胞或色素沉积在角膜后表面被称为膜后表面被称为KP，其形成需，其形成需要角膜内皮损伤和炎性细胞或色要角膜内皮损伤和炎性细胞或色素细胞的同时

8、存在素细胞的同时存在o 分类：分类：粉尘状粉尘状KP（淋巴淋巴/浆浆）羊脂状羊脂状KP（类上皮类上皮/巨噬巨噬）色素性色素性KP前葡萄膜炎前葡萄膜炎体征体征9The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University10The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical

9、 college,Xian Jiaotong Universityn 房水闪辉房水闪辉Aqueous flare：在炎症时虹膜睫状体的血管扩张，大在炎症时虹膜睫状体的血管扩张，大量的蛋白质或纤维素成分及炎性细胞渗出量的蛋白质或纤维素成分及炎性细胞渗出至房水中使房水变得混浊不清至房水中使房水变得混浊不清前葡萄膜炎前葡萄膜炎体征体征11The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityn 前房细胞：

10、前房细胞：o 主要为炎性细胞主要为炎性细胞o 裂灯下表现为大小裂灯下表现为大小一致的灰白色颗粒一致的灰白色颗粒o 炎性细胞运动规律炎性细胞运动规律o 前房积脓前房积脓Hypopyon前葡萄膜炎前葡萄膜炎体征体征12The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityn 虹膜改变：虹膜改变：o 虹膜后粘连虹膜后粘连Posterior synechia of the iriso 虹膜膨隆虹膜膨隆Iri

11、s bombeo 虹膜前粘连虹膜前粘连Anterior synechia of the iriso 房角粘连房角粘连Goniosynechia前葡萄膜炎前葡萄膜炎体征体征虹膜后粘连虹膜膨隆，房角粘连13The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityn 瞳孔改变：瞳孔改变：o 梅花状、梨状、梅花状、梨状、不规状瞳孔不规状瞳孔o 瞳孔闭锁瞳孔闭锁Seclusion of pupilo 瞳孔膜闭瞳

12、孔膜闭Occlusion of pupil前葡萄膜炎前葡萄膜炎体征体征14The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityn 晶状体改变：晶状体改变：o晶体表面环形色素晶体表面环形色素o晶体表面斑块状色素晶体表面斑块状色素n 眼后段改变：眼后段改变：o前玻璃体炎性细胞前玻璃体炎性细胞o偶见反应性黄班囊样水偶见反应性黄班囊样水肿或视盘水肿肿或视盘水肿前葡萄膜炎前葡萄膜炎体征体征15The sec

13、ond hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo 前葡萄膜炎并发症前葡萄膜炎并发症n 继发性青光眼：继发性青光眼：n 并发性白内障并发性白内障n 低眼压和眼球蒌缩低眼压和眼球蒌缩前葡萄膜炎前葡萄膜炎16The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,X

14、ian Jiaotong Universityo诊断诊断Diagnosis：n 诊断依据：睫状充血；诊断依据：睫状充血；KP；房水闪辉；瞳；房水闪辉；瞳孔缩小；虹膜后粘连。其中以孔缩小；虹膜后粘连。其中以KP和房水闪和房水闪辉阳性最为重要辉阳性最为重要n 仅有虹膜后粘连、晶体前表面色素沉着，有仅有虹膜后粘连、晶体前表面色素沉着，有虹睫炎病史，而无睫状充血、虹睫炎病史，而无睫状充血、KP和房水闪和房水闪辉等活动性病变则诊断为陈旧性虹睫炎辉等活动性病变则诊断为陈旧性虹睫炎n 病因诊断困难，注意有无关节、消化道和免病因诊断困难，注意有无关节、消化道和免疫性疾病疫性疾病前葡萄膜炎前葡萄膜炎17The

15、second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University签别诊断签别诊断 急性结膜炎急性结膜炎 虹睫炎虹睫炎 急闭青光眼急闭青光眼 充血充血 结膜性结膜性 睫状睫状/混合混合 混合性混合性角膜角膜 透明透明 透明透明KP 水肿水肿瞳孔瞳孔 正常正常 小小 大大眼压眼压 正常正常 大多正常大多正常 高高前葡萄膜炎前葡萄膜炎18The second hospital of Medical college,Xian

16、 Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo治疗治疗Treatment-散大瞳孔散大瞳孔n 目的目的:o 防止虹膜后粘连、瞳孔闭锁，以减少继发性青光防止虹膜后粘连、瞳孔闭锁，以减少继发性青光眼眼o 解除或减少虹膜括约肌和睫状肌痉挛，使其处于解除或减少虹膜括约肌和睫状肌痉挛，使其处于休息状态，刺激症状减轻，有利于病情的恢复。休息状态，刺激症状减轻，有利于病情的恢复。o 促进睫状体的血液循环促进睫状体的血液循环前葡萄膜炎前葡萄膜炎19The second hospital o

17、f Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityn 常用药物：常用药物：o 炎症活动期给予炎症活动期给予 2%后马托品眼膏后马托品眼膏1836ho 瞳孔散不大时给予强散瞳剂瞳孔散不大时给予强散瞳剂0.2ml结膜下注射结膜下注射o 炎症恢复期给予托品酰胺滴眼液炎症恢复期给予托品酰胺滴眼液前葡萄膜炎治疗前葡萄膜炎治疗20The second hospital of Medical college,Xian Jiaotong Univers

18、ityThe second hospital of Medical college,Xian Jiaotong Universityn 局部局部o 0.5%考的松滴眼液点眼考的松滴眼液点眼o 庆大霉素庆大霉素2万万u十地塞米松十地塞米松 5mg结膜下注射结膜下注射n 全身全身o 0.9%NS250ml+D.X.M10mg静脉滴注静脉滴注o 强的松：强的松：20mg,q.d.前葡萄膜炎前葡萄膜炎-治疗治疗21The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical c

19、ollege,Xian Jiaotong Universityn 抗前列腺素类药物：抗前列腺素类药物：o 阿斯匹林阿斯匹林0.5 tido 消炎痛消炎痛25mg tidn 病因治疗：病因治疗：o 感染感染抗菌素抗菌素o 结核结核抗结核抗结核前葡萄膜炎前葡萄膜炎-治疗治疗22The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityn 并发症治疗并发症治疗o 瞳孔阻滞导致的青光眼瞳孔阻滞导致的青光眼虹膜根

20、切术虹膜根切术o 房角堵塞导致的青光眼房角堵塞导致的青光眼滤过手术滤过手术o 并发性白内障只要光感光定位准确并发性白内障只要光感光定位准确 ECCE+IOL或或PHACO+IOLo 低眼压或眼球萎缩目前尚无有效治疗方法，必要低眼压或眼球萎缩目前尚无有效治疗方法，必要时为维持眼球形态，作羟基磷灰石人工义眼台植时为维持眼球形态，作羟基磷灰石人工义眼台植入。入。前葡萄膜炎前葡萄膜炎-治疗治疗23The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xi

21、an Jiaotong University三、中间葡萄膜炎三、中间葡萄膜炎Intermediate uveitiso概述概述n 主要累及睫状体平坦部、玻璃体基底部、周主要累及睫状体平坦部、玻璃体基底部、周边视网膜和脉络膜的炎症性和增殖性疾病边视网膜和脉络膜的炎症性和增殖性疾病n 多见于儿童、多见于儿童、40岁以下年轻人，常累及双岁以下年轻人，常累及双眼，可先后或同时发病眼，可先后或同时发病n 1979年国际葡萄炎研究组命名为中间葡萄年国际葡萄炎研究组命名为中间葡萄膜炎膜炎24The second hospital of Medical college,Xian Jiaotong Univer

22、sityThe second hospital of Medical college,Xian Jiaotong Universityo 症状：轻者无，重则飞蚊症，视物模糊症状：轻者无，重则飞蚊症，视物模糊o 体征：体征：n 眼前段：羊脂状眼前段：羊脂状/尘状尘状KP，轻度房闪，轻度房闪/房水房水中细胞。无睫状充血但儿童可中细胞。无睫状充血但儿童可n 眼后段：玻璃体雪球状混浊，睫状体平坦部眼后段：玻璃体雪球状混浊，睫状体平坦部雪堤样改变雪堤样改变，周边网膜静脉周围炎，周边网膜静脉周围炎n 易发生周边网膜血管炎及网膜脉络膜炎易发生周边网膜血管炎及网膜脉络膜炎中间葡萄膜炎中间葡萄膜炎25The s

23、econd hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University中间葡萄膜炎中间葡萄膜炎26The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo并发症并发症n 黄斑囊样水肿黄斑囊样水肿:n 并发性白内障：并发性白内障：中

24、间葡萄膜炎中间葡萄膜炎27The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo诊断诊断n 根据典型的玻璃体雪球状混浊，睫状体平根据典型的玻璃体雪球状混浊，睫状体平坦部雪堤样改变，周边网膜静脉周围炎即坦部雪堤样改变，周边网膜静脉周围炎即可诊断可诊断n 对飞蚊症有加重倾向，不能以其它原因解对飞蚊症有加重倾向，不能以其它原因解释的晶体后囊下混浊或黄斑囊样水肿应结释的晶体后囊下混浊或黄斑囊样水肿应结合三

25、面镜，间接检眼镜，检查，综合分析，合三面镜，间接检眼镜，检查，综合分析，作出诊断作出诊断中间葡萄膜炎中间葡萄膜炎28The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo治疗治疗n 对症治疗为主对症治疗为主n 视力视力0.5但伴有玻璃体混浊给予但伴有玻璃体混浊给予结膜下注射结膜下注射DXM5mg或选用强的松或选用强的松20mg qdn 网膜新生血管给予网膜新生血管给予YAG激光治疗激光治疗n 如炎

26、症继续加重可用免疫抑制剂，环磷酰胺，如炎症继续加重可用免疫抑制剂，环磷酰胺，环胞素治疗环胞素治疗中间葡萄膜炎中间葡萄膜炎29The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University三、后葡萄膜炎三、后葡萄膜炎(脉络膜炎脉络膜炎)o概述概述n 它包括了脉络膜、玻璃体后部及视网膜的炎性它包括了脉络膜、玻璃体后部及视网膜的炎性病变病变n 脉络膜有睫状后动脉供血，脉络膜有睫状后动脉供血，可单独发病可单独发病n

27、 视网膜外层由脉络膜供血，脉络膜视网膜炎，视网膜外层由脉络膜供血，脉络膜视网膜炎，甚至视神经视网膜炎甚至视神经视网膜炎n 按病灶分布，可分为局灶型、播散型及弥漫型按病灶分布，可分为局灶型、播散型及弥漫型30The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University后葡萄膜炎后葡萄膜炎o病因病因n 感染性：如细菌，真菌，寄生虫和病毒感染性：如细菌，真菌，寄生虫和病毒n 非感染性：如免疫性或过敏性及对坏死非

28、感染性：如免疫性或过敏性及对坏死组织的炎性反应组织的炎性反应31The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo临床表现临床表现n 脉络膜炎时眼部症状轻。位于前方仅有黑影；脉络膜炎时眼部症状轻。位于前方仅有黑影；后极部者，视物变形、中心视力减退后极部者，视物变形、中心视力减退n 眼前段无充血及炎症改变眼前段无充血及炎症改变n 尘埃状及絮状玻璃体浑浊尘埃状及絮状玻璃体浑浊n 活动期病灶灰黄色，

29、视网膜水肿混浊活动期病灶灰黄色，视网膜水肿混浊n 瘢痕期炎症消退，脉络膜萎缩，遗留色素脱瘢痕期炎症消退，脉络膜萎缩，遗留色素脱失及瘢痕组织失及瘢痕组织后葡萄膜炎后葡萄膜炎32The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo并发症并发症n 黄斑水肿黄斑水肿n 视盘充血水肿视盘充血水肿n 视网膜血管炎视网膜血管炎n 视网膜脱离视网膜脱离n 眼球萎缩眼球萎缩后葡萄膜炎后葡萄膜炎33The seco

30、nd hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo鉴别诊断鉴别诊断n 眼内肿瘤：根据超声波、眼内肿瘤：根据超声波、X线、线、FFA区别区别n 老年性黄斑盘状变性老年性黄斑盘状变性n 脉络膜渗漏：此脱离部位随体位改变脉络膜渗漏：此脱离部位随体位改变n 视网膜色素变性视网膜色素变性后葡萄膜炎后葡萄膜炎34The second hospital of Medical college,Xian Jiaotong Un

31、iversityThe second hospital of Medical college,Xian Jiaotong Universityo治疗治疗n 理想治疗：病因理想治疗：病因n 非特异性治疗法：如伴前节炎症，散瞳、非特异性治疗法：如伴前节炎症，散瞳、睫状肌麻痹剂、局部激素；后葡萄膜炎及睫状肌麻痹剂、局部激素；后葡萄膜炎及全葡萄膜炎需全身激素治疗；非甾体类抗全葡萄膜炎需全身激素治疗；非甾体类抗炎剂；免疫抑制剂炎剂；免疫抑制剂n 最好是病因治疗，原因不明、病情严重者最好是病因治疗，原因不明、病情严重者可试用广谱抗生素可试用广谱抗生素后葡萄膜炎后葡萄膜炎35The second hospi

32、tal of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University四、全葡萄膜炎四、全葡萄膜炎o累及前、中、后、整个葡萄膜的累及前、中、后、整个葡萄膜的炎症称为全葡萄膜炎炎症称为全葡萄膜炎o治疗同上治疗同上36The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Un

33、iversity五、几种常见的特殊葡萄炎五、几种常见的特殊葡萄炎o强直性脊椎炎强直性脊椎炎oBehcet病病o交感性眼炎交感性眼炎oFuchs综合症综合症37The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo强直性脊椎炎强直性脊椎炎Ankylosing sopndylitisn 是一种病因不清、主要累及轴骨骼的特发性是一种病因不清、主要累及轴骨骼的特发性炎症疾病，并发急性前葡萄炎，发于青壮年炎

34、症疾病，并发急性前葡萄炎，发于青壮年男性。男性。n 往往双眼交替性发作，易复发。往往双眼交替性发作，易复发。n 诊断：主诉腰骶部疼痛诊断：主诉腰骶部疼痛n 治疗：同前葡萄膜炎治疗：同前葡萄膜炎38The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong UniversityoBehcet病病n 定义：一种以复发性葡萄膜炎、口腔溃疡、定义：一种以复发性葡萄膜炎、口腔溃疡、皮肤多形性损害、生殖器溃疡为特征多系统皮肤多形性损害、

35、生殖器溃疡为特征多系统受累的疾病。受累的疾病。n 临床表现临床表现o 眼部损害眼部损害o 口腔溃疡口腔溃疡o 皮肤损害皮肤损害o 生殖器溃疡生殖器溃疡39The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo 国际国际Behcet病研究组诊断标准病研究组诊断标准n 1.复发性口腔溃疡（一年至少复发三次）复发性口腔溃疡（一年至少复发三次）n 2.下面下面4项中出现项中出现2项即可确诊项即可确诊n A

36、.复发性生殖器溃疡或生殖器瘢痕复发性生殖器溃疡或生殖器瘢痕n B.前后葡萄膜炎，玻璃体内细胞或网膜血管炎前后葡萄膜炎，玻璃体内细胞或网膜血管炎n C.皮肤结节性红斑，假毛囊炎，痤疮样结节皮肤结节性红斑，假毛囊炎，痤疮样结节 n D皮肤过敏反应阳性皮肤过敏反应阳性Behcet病病40The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong UniversityBehcet病病o治疗：治疗：n 前段受累前段受累-阿托品点眼阿托

37、品点眼n 糖皮质激素，一般为糖皮质激素，一般为20-30mg/dn 免疫抑制剂：环胞霉素免疫抑制剂：环胞霉素A 5mg（kg.d）n 并发性白内障、继发性青光眼在炎症完全并发性白内障、继发性青光眼在炎症完全控制下可考虑手术控制下可考虑手术41The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo交感性眼炎交感性眼炎Sympathetic ophthalmian 概念：指发生于一眼穿通伤或内眼术后的

38、双概念：指发生于一眼穿通伤或内眼术后的双侧肉芽肿性葡萄膜炎称为交感性眼炎侧肉芽肿性葡萄膜炎称为交感性眼炎n 受伤眼称为诱发眼；另一眼侧称为交感眼受伤眼称为诱发眼；另一眼侧称为交感眼n 病因：主要由外伤或手术造成眼内抗原暴露病因：主要由外伤或手术造成眼内抗原暴露并激发自身免疫应答所致并激发自身免疫应答所致42The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong University交感性眼炎交感性眼炎n 临床表现：临床表

39、现：o 可发生于外伤或手术后可发生于外伤或手术后5d至至56年内，但多发生年内，但多发生于于2周至周至2个月内。个月内。o 一般发病隐匿，为肉芽肿性炎症，可表现为前葡一般发病隐匿，为肉芽肿性炎症，可表现为前葡萄膜炎、后葡萄膜炎、中间葡萄膜炎和全葡萄膜萄膜炎、后葡萄膜炎、中间葡萄膜炎和全葡萄膜炎，其中以全葡萄膜炎为多见。炎，其中以全葡萄膜炎为多见。43The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universi

40、tyn 诊断：诊断：o 眼球穿通伤或内眼手术史对此病诊断有重要价值眼球穿通伤或内眼手术史对此病诊断有重要价值（与（与Vogt-小柳原田病鉴别的重要依据）小柳原田病鉴别的重要依据）o FFA可见视网膜色素上皮和脉络膜水平的多灶性可见视网膜色素上皮和脉络膜水平的多灶性渗漏及染料积存的现象，可伴有视盘染色。渗漏及染料积存的现象，可伴有视盘染色。交感性眼炎交感性眼炎44The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Un

41、iversityn 治疗：治疗：o 对眼前段受累者，可给予糖皮质激素点眼和睫状对眼前段受累者，可给予糖皮质激素点眼和睫状肌麻痹剂等治疗；对于表现为后葡萄膜炎和全葡肌麻痹剂等治疗；对于表现为后葡萄膜炎和全葡萄膜炎者，则应选择糖皮质激素口服或其他免疫萄膜炎者，则应选择糖皮质激素口服或其他免疫抑制剂。抑制剂。交感性眼炎交感性眼炎45The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityn 预防预防o 眼球

42、穿通伤后及时修复创口，避免葡萄膜嵌顿及眼球穿通伤后及时修复创口，避免葡萄膜嵌顿及预防感染，对此病可能有预防作用。预防感染，对此病可能有预防作用。o 关于摘除伤眼是否有预防作用，尚有争议。对有关于摘除伤眼是否有预防作用，尚有争议。对有望保存视力和眼球者，应尽可能修复伤口。对修望保存视力和眼球者，应尽可能修复伤口。对修复无望的眼球破裂，可慎行眼球摘除术。复无望的眼球破裂，可慎行眼球摘除术。交感性眼炎交感性眼炎46The second hospital of Medical college,Xian Jiaotong UniversityThe second hospital of Medical college,Xian Jiaotong Universityo小结：小结：n 前葡萄膜炎临床表现、诊断、治疗、并发症前葡萄膜炎临床表现、诊断、治疗、并发症n Behcet病、交感性眼炎概念病、交感性眼炎概念47