RETINAL ARTERITIS COMPLICATING HERPES ZOSTER OPHTHALMICUS
RETINAL ARTERITIS COMPLICATING HERPES ZOSTER OPHTHALMICUS
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DOI：
10.1136/bjo.57.5.344
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发表时间：
1973-01-01
影响因子：
4.1
通讯作者：
MENDIS, U
中科院分区：
文献类型：
--
作者：
BROWN, RM;MENDIS, U
本例患者括约肌坏死后出现的斑片状坏死后虹膜萎缩与急性闭角型青光眼发作后的虹膜萎缩相似。在带状疱疹中，坏死可能主要是由于血管炎继发的缺血引起的（Naumann，Gass，and Font，I968）。然而，眼内压的升高也可能导致这些萎缩性改变。在该患者中观察到的上鼻动脉和上颞动脉分支的广泛狭窄和渗出物以及虹膜变化似乎符合Feyrter（I954）的原始假设，即带状疱疹基本上是一种类似于结节性多动脉炎并与之相关的血管疾病，尽管大多数研究者对神经周围的变化比对血管周围的变化印象更深。武装部队病理学研究所登记处记录的HZO后摘除的眼睛的组织学检查显示，在报告的21例病例中，有12例视网膜中存在不同程度的血管周炎和血管炎（Naumann等，1968）。然而，这些病例中未报告眼底变化。轻微的眼底改变在HZO中可能比我们认为的更常见。此外，这种情况下眼部反应的严重程度可能与抗代谢药治疗导致的免疫状态改变有关。
Discussion The patchy postnecrotic iris atrophy after sphincter neciosis seen in this patient resembles that seen after an attack of acute-closed angle glaucoma. In herpes zoster, the necrosis probably occurs mainly as a result of ischaemia secondary to vasculitis (Naumann, Gass, and Font, I968). However, the rise in intraocular pressure may also have contributed to these atrophic changes.The extensive narrowing of the branches of upper nasal and upper temporal arterioles, with exudates, and the iris changes seen in this patient would seem to fit the original hypothesis of Feyrter (I954) that herpes zoster is basically a vascular disease resembling and related to polyarteritis nodosa, although most investigators have been more impressed by the perineural than by the perivascular changes. Histopathological examination of eyes enucleated after HZO on record in the Registry of the Armed Forces Institute of Pathology have shown perivasculitis and vasculitis of varying intensity in the retina in twelve of the 2I cases reported (Naumann and others, I968). However, no fundus changes were reported in these cases. It is possible that minor fundus changes are more common in HZO than is believed. In addition, the severity of the ocular reaction in this case may be related to the altered immunological status as a result of the treatment with antimetabolites.