目的:后葡萄膜炎是一种常见的脉络膜视网膜病变,影响全球所有年龄段,并且是转诊到视网膜诊所的常见原因。葡萄膜炎的病因范围非常广泛,包括传染性和自身免疫性疾病。炎症可以局限于眼睛或可能是全身性疾病的一部分。因此,提出了一个有用的大纲,以帮助正确诊断这些具有挑战性的实体。由于许多肿瘤条件类似于后葡萄膜炎的特征,情况变得更加复杂;它们被称为“葡萄膜炎的伪装者”。这里,我们总结了不同的后部uveitides,它们具有罕见的发现,以及难以区分的伪装者。由于诊断的不确定性,这些情况造成了诊断困境,导致治疗延迟。
方法:对MEDLINE/PUBMED进行了广泛的文献检索,1985年1月至2022年1月的EBSCO和CochraneCENTRAL数据库,用于对包括后葡萄膜实体在内的预定诊断进行原始研究和评论,全葡萄膜炎和化装舞会综合症.
结果:我们描述了可以表现为后葡萄膜炎模拟者的条件(即,免疫检查点抑制剂和Vogt-Koyanagi-Harada样葡萄膜炎;白血病和淋巴瘤相关的后葡萄膜炎),作为视网膜疾病的模仿者存在的炎症状态(即,Purtscher样视网膜病变表现为系统性红斑狼疮;中心性浆液性脉络膜视网膜病变掩盖炎性渗出性视网膜脱离),和具有罕见和诊断挑战性病因的葡萄膜疾病(即,抗TNF-α的矛盾炎症作用;疫苗接种后葡萄膜炎;玻璃体内注射抗血管生成药物后的眼部炎症)。
结论:对独特的后葡萄膜炎病例的回顾强调了后葡萄膜炎的重叠特征(抗TNFα和葡萄膜炎的矛盾炎症作用;Purtscher样视网膜病变作为系统性红斑狼疮的表现,...)和视网膜疾病的性质(缺血性眼部综合征,或视网膜中央静脉阻塞,淀粉样变性,遗传性疾病如色素性视网膜炎,常染色体显性遗传性新生血管性炎性玻璃体视网膜病变(ADNIV),等。...)可以模仿它们的代表。仔细回顾过去的葡萄膜炎病史,目前的药物和最近的疫苗接种,详细检查过去或现在的炎症迹象,最终进行基因检测和/或多模态视网膜成像(如荧光素血管造影术,EDI-OCT,用于狼疮Purtscher样视网膜病变评估的OCT血管造影,或ICG用于中心性浆液性视网膜病变,或视网膜淀粉样血管病)可能有助于正确诊断。
OBJECTIVE: Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as \"masqueraders of uveitis\". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty.
METHODS: An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes.
RESULTS: We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs).
CONCLUSIONS: This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.