178例病毒性角膜炎伴发色素膜炎治疗分析

目的：探讨病毒性角膜炎伴发色素膜炎的临床特点、发病机理与治疗方法。方法：对178例患者的临床资料进行分析。结果：126例盘状角膜基质炎伴发色素膜炎的患者,临床治愈123例（治愈率97.6%）;随访1～5年,复发43例（复发率34.1%）。52例角膜内皮炎伴发色素膜炎的患者,临床治愈50例（治愈率96.1%）;随访1～5年,复发17例（复发率32.7%）。结论：病毒是引起角膜基质炎及角膜内皮炎主要病原,而只有在复发时免疫成分才具有重要性。盘状角膜基质炎伴发色素膜炎治疗原则是加强抗病毒治疗,再适当联合糖皮质激素治疗：角膜内皮炎伴发色素膜炎治疗原则是加强糖皮质激素和免疫抑制剂（环孢霉素A）联合应用,再适当应用抗病毒药物治疗。伴发青光眼的患者以抗炎治疗为主,同时加用降眼压的药物。

Treatment of viral keratitis associatie with uveitis of 178 Cases

Objective: To investigate the clinical characteristics,pathogenesis and treatment of viral keratitis-associated uveitis.Methods: To analyze and summarize the clinical information of 178 patients.Results: In 126 patients of disciform interstitial keratitis-associated uveitis,123 patients were cured(97.6% of cure rate);43 cases were recurrent after 1 to 5 years' follow-up(34.1% of recurrence rate).In 52 patients of corneal endotheliitis-associated uveitis,50 patients were cured(a cure rate of 96.1%);17 cases were recurrent after 1 to 5 years' follow-up(a recurrence rate of 32.7%).Conclusion: Viruses tend to be the major etiological agent of the interstitial keratitis and corneal endotheliitis,while only in recurrent cases,immunoagents play an important role.The therapeutic principle of interstitial keratitis-associated uveitis should be to emphasize the antiviral therapy and supplement with glucocorticoid therapy is appropriate.The therapeutic principle of corneal endotheliitis-associated uveitis should be to emphasize the glucocorticoid and immunodepressant therapy(eg.Cyclosporine A),and supplement with antiviral therapy as appropriate.The anti-inflammatory therapy is very important to the patients of secondary glaucoma,while reducing intraocular pressure drugs were also necessary.