获得性免疫缺陷综合征并发动眼神经麻痹的临床特征

目的观察就诊于眼科的获得性免疫缺陷综合征并发单侧动眼神经麻痹的眼部表现、系统特征和治疗情况。方法回顾分析4例4眼艾滋病并发单侧动眼神经麻痹患者的眼部表现、视敏度、色觉检查、上睑下垂程度、瞳孔及眼外肌受累、复视情况;CD4+T淋巴细胞计数,给予口服高效抗逆转录病毒药物治疗联合抗病毒药物治疗,随诊观察2～6个月。结果初诊时检查,视敏度2眼为6/9,1眼为6/18,1眼为6/36;色觉检查均正常;上睑下垂3例为重度,1例为中度;瞳孔扩大固定,直径为5～7mm;水平性复视,眼球处于外转位,外转正常、不能向上、下、内转动,CD4+T淋巴细胞计数1例为200个/ul,3例介于100～200个/ul之间;经高效抗逆转录病毒药物治疗后CD4+T淋巴细胞计数上升到≥300个/ul。结论排除颅内、眶内占位,其他因素所致脑梗塞,对不明原因的单眼动眼神经麻痹患者,建议作血清人类免疫缺陷病毒(Human immunodeficiency virus,HIV)抗体检测,避免漏诊误诊。

Clinical feature of acquired immune deficiency syndrome complicated oculomotor nerve palsy

Objective To investigate the ocular characteristics,systemic features and therapeutic condition of oculomotor nerve palsy associated with acquired immune deficiency syndrome（AIDS）.Methods Ocular features,visual acuity,color vision examination,ptosis,pupil changes,diplopia and extraocular muscle move limited,and CD4＋T lymphocyte counts of 4 eyes（4 patients） of oculomotor nerve palsy associated with acquired immune deficiency syndrome（AIDS） were analyzed.To take highly active antiretroviral therapy（HAART） with cyclopentolate or acyclovir or gamciclovir etc medicines treatment,The time of follow-up was 2～6 months.Results In initial examination,visual acuity of the patients was as following：2 eyes 6/9,1 eye 6/18,1 eye 6/36;Color vision examination 4 eyes were normal;Ptosis 3 eyes severe,1 eye is secondary degree;pupil size fixed,diameter 5～7mm;horizontal diplopia;Eyeball is located turn to external,not adduction,not supraduction,elevation,not infraduetion,depression;CD4＋T lymphocyte counts 1 patient is 200 cells/ul,3 patients are 100～200 cells/ul.after highly active antiretroviral therapy treatment with antiviral treatment,CD4＋T lymphocyte counts≥300 cells/ul.Conclusion For the patients with single eye occur oculomotor nerve palsy of underfined cause,the antibody of serological anti-human immunodeficiency virus（HIV） should be screened.