关键词: 结核性匐行样脉络膜炎, 抗结核治疗, 糖皮质激素

Abstract: Objective To observe the short-term efficacy of antitubercular drugs combined with corticosteroids in the treatment of tubercular serpiginous-like choroiditis, and explore the factors that may affect the treatment. Design Retrospective case series. Participants 16 patients (20 eyes) with tubercular serpiginous-like choroiditis presented to Beijing Tongren Hospital from January 2016 to June 2019. Methods First-line 4-drug antitubercular therapy (isoniazid, rifampicin, ethambutol, pyrazinamide) were given initially for 2 months. Thereafter, rifampicin and isoniazid were continued for another 4 months. Oral corticosteroids (prednisolone 1 mg/kg/day initially) were administered 2 weeks later than antitubercular therapy, then gradually tapered off depending on the clinical response and last for 6 months. Following-up was conducted 1, 2, 3, and 6 months after the combined therapy. During the follow-up, color fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT) and vitreous cells were recorded. Main Outcome Measures Numbers of eyes with effectiveness or recurrence, complication. Results 11 patients with 13 eyes (68.8%) had stable lesions after antitubercular drugs combined with corticosteroids therapy, and 8 patients (72.7%) strictly followed the dosing regimen. Ten people were administered corticosteroids systemically before anti-tuberculosis, of which 5 (50%) patients had active lesions at 6 months, 1 eye (5%) developed choroidal neovascular (CNV). 6 patients who were without corticosteroids history before antitubercular all showed stable fundus at the end of the follow-up. Conclusion The lesions of tubercular serpiginous-like choroiditis in most patients responded well to combined antitubercular and corticosteroids therapy. Patients who were administered large amounts of corticosteroids systemically before the antitubercular had a poor prognosis.

Key words: tubercular serpiginous-like choroiditis, antitubercular therapy, corticosteroids