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1、Uveal Tract Disease 葡萄膜病, Uveal Tract 葡萄膜包括: Iris 虹膜 Ciliary body 睫状体 Choroid 脉络膜 三者彼此相连,血供系统同源.,Uvitis 葡萄膜炎 Is the generic name of the inflammation of uvea ; retina ;retinal vessels and vitreous 葡萄膜、视网膜、视网膜血管和玻璃体炎症的总称 Always in young patient 多见于年轻人 Always combine with systemic autoimmune disease 常合
2、并全身自体免疫性疾病 recurrence is often 易复发 Always blind 常致失明, Autoimmunity: eyes have many antigen . Immune disorder lead to uveitis such as sympathetic uveitis Stills disease (juvenile rheumatoid arthritis) Harada-Vogt disease 自身免疫反应：眼有很多抗原，免疫异常导致葡萄膜炎。例如交感性眼炎、晶体过敏性眼内炎、 原田-小柳氏病、Behcet病等. 伴发葡萄膜炎自身免疫性疾病:风湿性关节
3、炎，系统性红斑狼疮. The function of metabolite of arachidonic acid always seen in surgery , drug and physical stimulation 氧自由基的作用 ：常见于手术、外伤、以及理化刺激等导致活性氧生成过多,造成组织损害-自身氧损伤.,Classification of uvitis 分类, classify in etiologyinfection or non-infection 病因分类感染和非感染 classify in pathologygranuloma or non-granuloma uve
4、itis 临床病理分类肉芽肿型和非肉芽肿型 classify in anatomy-1979 anterior ,intermediate ,posterior and panuveitis 解剖部位分前、中、后或全葡萄膜炎(现阶段国际通用分类方法),Anterior uveitis前葡萄膜炎,in China50-60% of uveitis are anterior uneitis 我国50-60葡萄膜炎病人是前葡萄膜炎 Including 3 types 三种类型 acute anterior uveitis 急性前葡萄膜炎 chronic anterior uveitis 慢性前葡萄膜
5、炎 acute or chronic anterior uveitis 既可出现急性炎症又可出现慢性炎症的前葡萄 膜炎,Acute Anterior Uveitis 急性前葡萄膜炎 Clinical features 临床表现 Symptoms of anterior Uvitis 症状 Aching pain in the eye 剧烈眼痛 Rapid blurring of vision 视力急速下降 Photophobia 怕光 Tearing of the eye 流泪,Signs of anterior uveitis 体症 Redness of the eye ciliary co
6、ngestion or mixed congestion 眼球充血。 睫状充血或混合 性充血KP( keratitis Precipitate ）three typesdust like or media size or suet like 角膜后沉着物 。有三种类型：尘埃状、中等大小羊脂状,KP is clumps of white cells and inflammatory debris The shape of distribution of Kp is triangle shape or in pupil area of cornea or diffused KP:成堆白血球和炎症碎
7、片，分布呈三角形或在瞳孔区或弥散分布Aqueous flare the damage of aqueous and blood barrier protein exudate into aqueous cells and flare in the anterior chamber -tyndall sign 房闪:血-房水屏障受损蛋白渗入前房,房水闪光阳性（丁道尔现象）, Hypopyon Aqueous cells inflamination cells red cells pigment cells inflammary cells percipitate in the lower par
8、t of anterior chamber 前房积脓。房水细胞、红细胞、上皮细胞 、炎症细胞沉积在前房下方, changes of iris 虹膜改变 iris edema and muddy 虹膜水肿、纹理不清 Posterior synechia of the iris pupil irregular 后粘连而瞳孔不规则 iris bombe 虹膜膨隆 Peripheral anterior synechia of the iris 周边前粘连 goniosynechia 房角粘连 iris nodules 虹膜结节, changes of pupil 瞳孔变化 Miosis Pupil
9、constriction: inflammatory spasm of the iris sphincter muscle 瞳孔缩小，由于瞳孔括约肌痉挛 irregular pupil 瞳孔不规则,Pupil posterior synechia 瞳孔后粘连,posterior Synechia 后粘连,Seclution of pupil 瞳孔闭锁,Goniosynechia 房角粘连,Occulusion of pupil 瞳孔膜闭,Iris bombe 虹膜膨隆, Seclusion of pupilsynechia in 360 degree 瞳孔闭锁360度后粘连 Occlusion
10、 of pupil-fibrous membrane cover the pupil 瞳孔膜闭纤维膜遮盖瞳孔区 lens -pigment participate in the anterior lens capsule ,after enlarge the posterior synechia pupil pigment remain 晶状体前囊有色素沉着，当拉开后粘连时，瞳孔区遗留色素。,posterior segment of eye changed 眼後段改变 vitreous opacity 玻璃体混浊 Particles in vitreous 玻璃体内有颗粒状物 reflecti
11、ve macular edema 反应性黄斑水肿,Complication 并发症 complicated cataract 并发性白内障 the aqueous changed matabolism of the lens 房水改变使晶状体代谢改变 Opacity under the posterior capsule.also due to long term use steroid drops 长期应用激素滴眼晶状体后囊下混浊,Secondary glaucoma 继发性青光眼 block the trebacular mash work peripherial anterior syn
12、echia pupil block the aqueous circle 小梁网阻塞以及瞳孔后粘连阻断房水循环Low IOP 低眼压 Atrophy of eyeball 眼球萎缩, Diagnosis 诊断 Diagnosis by Symptom and signs 根据症状和体征诊断 Pay attention to systemic condition specially Artheritis urea tract inflammation Reiter syndrome T.B.and syphilis etc. 注意全身情况特别是关节炎，结核，梅毒等合并 葡萄膜炎,Differen
13、tial diagnosis 鉴别诊断 some times tumor also have hypopyon. check B scan、 CT、MRI 前葡萄膜炎主要与急性结膜炎、急性青光眼鉴别。 肿瘤有时也可有前房积脓。应用B超、CT、 MRI 检查以明确诊断。, Treatment 治疗 Dilate the pupil instantly .prevent posterior synechia 立即散瞳，减轻炎症反应，预防后粘连。 release the pain due to the spasm of sphinter of pupil and ciliary muscle use
14、 mydriatic : 1-4% Homatropine not atropine posterior synechia use mixed mydriatics 应用散瞳剂如阿托品、后马托品或混合散瞳剂可缓解疼痛,Topical steroid 局部或周身应用皮质类固醇激素 NSAID nonsteriod anti-inflammatory drugs 应用非淄体消炎药如消炎痛、布洛芬等 Etiology therapy : antiinfection 病因治疗：抗感染complications in secondary glaucoma use diamox timolol 治疗并发症
15、如继发性青光眼应用降眼压药物 In pupil block laser iridotomy or peripherial Iridectomy is needed 瞳孔阻滞可激光虹膜打孔 或周边虹膜切除, Filter surgery is needed for the synechia of anterior chamber cases 广泛房角粘连应当应用青光眼滤过术 After control the inflammation do cataract surgery and IOLImplant systemic use steroids to prevent uveitis 控制炎症后
16、做白内障和人工晶体植入术，术前应先用激素以免葡萄膜炎复发,Intermediate uveitis 中间型葡萄膜炎,Clinical features 临床表现 Pars plana ciliary part and base of vitreous uveitis ;peripheral Retinal and choroid involved. 睫状体平坦部和玻璃体基底部葡萄膜炎。周边视网膜和脉络膜受累 Always 40y.both eyes chronic onset 常常为 40岁，双眼、发病缓慢,Sometimes have pain and red eyeSymptom: can no symptom or see as flying mosquito ,blured vision , temporary myopia 可无症状或仅有飞蚊症、视力模糊、一过性近视，有时有疼痛和红
