目的：探讨糖皮质激素在梅毒性葡萄膜炎治疗中的使用时机。

方法：回顾性研究。收集2008年1月至2021年1月确诊的梅毒性葡萄膜炎患者110例134眼，其中24例为双眼。出现眼部症状至就诊时间为1 d-3 mo。根据接受治疗情况分为三组：单纯抗生素组98眼单纯使用抗生素治疗(正规驱梅治疗)后1-2 wk，随访评估患者眼底病灶清除彻底，荧光素眼底血管造影(FFA)+吲哚青绿血管造影(ICGA)+光学相干断层扫描(OCT)无异常表现者； 先抗生素后激素组26眼经过正规驱梅治疗结束后1-2 wk，随访评估患者眼底病灶未彻底清除者，其中FFA可见视网膜血管壁染色或者ICGA脉络膜弱荧光未完全消退者； 先激素后抗生素组10眼为外院未明确病因情况下，按照“葡萄膜炎”治疗：生理盐水250 mL+地塞米松注射液10 mg，静滴，1次/日，共7-10 d，接受治疗后10-14 d通过血清学梅毒螺旋体颗粒凝集试验(TPPA)检查明确诊断梅毒感染性葡萄膜炎。比较三组患者治疗前后最佳矫正视力、裂隙灯检查、眼底照相、OCT、FFA、ICGA及预后。

结果：三组患者治疗前后最佳矫正视力、视盘，视网膜血管炎，脉络膜弱荧光，RPR滴度比较均有显著性差异。先激素后抗生素组患者预后均低于单抗生素组和先抗生素后激素组，先抗生素后激素组的预后为“佳”占比高于其他组。

结论：梅毒性葡萄膜炎早期诊断正规治疗整体预后良好，充分驱梅前给予大剂量糖皮质激素不利于病情恢复，正规驱梅后，有残留病灶的患者，小剂量糖皮质激素的应用可以促进病情恢复。

METHODS: A retrospective study was conducted in 110 patients(134 eyes)with syphilitic uveitis diagnosed from January 2008 to January 2021, of whom 24 were binocular. The time from onset to treatment was 1 d to 3 mo. They were divided into three groups according to the treatment, including 98 eyes with completed clearely fundus lesions and no abnormalities in fundus fluorescein angiography(FFA)+ indocyanine green angiography(ICGA)+ optical coherence tomography(OCT)after treated with antibiotics alone for 1 to 2 wk in single antibiotics group, 26 eyes with in completely cleared fundus lesions and retinal vessels wall staining observed by FFA or choroidal weak fluorescence observed by ICGA after standard antisyphilitic treatments for 1 to 2 wk in first antibiotics followed by hormones group, and 10 eyes treated according to uveitis at other hospital in the absence of a clear cause of disease, that was intravenously dripped with 250 mL of normal saline and 10 mg of dexamethasone once a day for 7 to 10 d in total, then clearly diagnosed as syphilitic uveitis by Treponema pallidum particle agglutination(TPPA)test after receiving treatment for 10 to 14 d in hormones followed by antibiotics group. The best corrected visual acuity, slit-lamp examination, fundus photography, OCT, FFA, ICGA and prognosis of the three groups of patients were compared.

RESULTS: There were statistically significant difference in the best corrected visual acuity, optic disc, retinal vasculitis, choroidal weak fluorescence, and RPR titer before and after treatment of the three groups of patients. The prognosis of the hormones followed by antibiotics group was lower than that in the single antibiotics group and antibiotics followed by hormones group, and the proportion of “good” prognosis in the antibiotics followed by hormones group was larger than that in other groups.

CONCLUSION: Early diagnosis and regular treatment of syphilitic uveitis has a good overall prognosis, and giving large doses of glucocorticoids before thorough antisyphilitic treatments is not conducive to the recovery of disease. In patients with residual lesions after standard antisyphilitic, the application of small doses of glucocorticoids is helpful for the recovery of the disease.