全身性紅斑狼瘡視網膜病變之臨床觀察

Clinical Observation of Lupus Retinopathy

沈秉衡(Bing-Herng Shen) ； 蔡顯楊(Hsien-Yang Tsai)

《中華民國眼科醫學會會刊》 28卷2期 (1989/05) Pp. 820-829

https://doi.org/10.30048/ACTASOS.198905.0151

摘要

全身性紅斑狼瘡是一種可侵犯全身多處器官系統的自體免疫疾病，在眼睛，它也可造成多樣化的變化，其中以侵犯眼底視網膜血管之病變對視力影響最大。我們觀察了33位全身性紅斑狼瘡之病人，其中女性30人，男性3人，接受檢查之初病情為活動性的有25人。歸納其眼底變化計有七項：(1)微小血管病變(Microangiopathy)：例如微小動脈瘤，微血管阻塞。(2)棉絮狀滲出物(Cotton-wool spots)。(3)視網膜血管炎(Retinal vasculitis)：可造成視網膜血管阻塞，導致中心視網膜動脈阻塞，中心視網膜靜脈阻塞或側枝靜脈阻塞之厲害變化。(4)球後神經炎(Retrobulbar neuritis)。(5)脈絡膜血管病變合併浮出性視網膜剝離(Choroidopathy with exudative retinal detachment)。(6)次發性變化：包括新生血管，玻璃體出血及新生血管性青光眼。(7)其他變化：包括一例眼底結核菌肉芽腫與兩例Chloroquine視網膜病變。觀察這些眼底變化，我們發現輕微的眼底變化經治療後可消失，視力也能保持良好；但若發生視網膜血管炎，則呈現進行性血管阻塞甚至有次發性變化。對於血管炎之病人，我們建議以泛網膜雷射光凝固法治療。全身性紅斑狼瘡之病人也應在眼科定期追踪檢查。

並列摘要

Systemic lupus erythematosus is such a kind of automimmune disease which can attack multiple organ systems of the body, including eyes. The ocular involvements can affect eyelids, anterior segment, fundus, optic nerve, and visual pathway. We retrospectively collected 33 SLE patients, 30 females and 3 males, to observe their fundus changes and progressions. There were 25 patients in the active stage of disease during this study. The fundus changes included: (1) microangiopathy, (2) cotton-wool spots, (3) retinal vasculitis: severe vaso-occlusive disease and some of them can mimic CRAO, CRVO, and BRVO, (4) retrobulbar neuritis, (5) choroidopathy with exudative retinal detachment, (6) secondary changes: neovascularization, vitreous hemorrhage, neovascular glaucoma, (7) others: one case of bilateral tuberculoma and two cases of chloroquine retinopathy. From our observation, minor changes, such as microangiopathy and cotton- wool spots, could disappear after medical treatment. But retinal vasculitis was always progressive and irreversible and even secondary changes could happen. So we recommend early treatment with panretinal photocoagulation to the retinal vasculitis to preserve the vision. In addition to the medical treatment, SLE patients should be followed regularly by opthalmologists, too.

並列關鍵字

Lupus retinopathy ； Microangiopathy ； Cotton-wool spots ； Retinal vasculitis