方法：回顾性分析本院2010-01/2014-02收治VKHS 45例90眼。按糖皮质激素种类不同分为两组：观察组25例50眼：静滴注射用甲基强的松龙(1.0g)3d后，减量为0.5g治疗2d，然后改为晨起顿服强的松片(60mg)； 对照组20例40眼：静滴地塞米松注射液(12mg)5d，然后改为晨起顿服强的松片(60mg)。两组均随炎性反应减轻逐渐减量，每次减5mg，当药物减至15～20mg时，维持治疗>6mo，再逐渐减量直至停药，总疗程≥9mo。观察分析治疗前后患者视力、光学相干断层扫描(optical coherence tomography，OCT)及荧光素眼底血管造影(fundus fluorescein angiography，FFA)变化情况。

结果：两组治疗前视力差异无统计学意义，治疗5d后视力均有提高，且观察组视力(0.44±0.19)优于对照组(0.55±0.29)，差异有统计学意义(P<0.05)； 治疗15d后，两组视力均进一步提高，观察组视力(0.32±0.17)好于对照组(0.39±0.22)，差异无统计学意义； 治疗30d后，两组视力基本恢复正常。治疗前有84眼(93%)OCT检查显示视网膜黄斑中心凹存在神经上皮层脱离或视网膜浆液性脱离，脱离高度为观察组1009.67±319.40μm，对照组1098.13±283.45μm。治疗5d后，两组视网膜下积液明显吸收，观察组脱离高度(307.79±71.35μm)低于对照组(434.13±88.67μm)，两组间差异有显著统计学意义(P<0. 01)； 治疗15d后，两组黄斑中心凹视网膜下液基本吸收，观察组为290.61±52.55μm，对照组为296.55±61.57μm，差异无统计学意义； 治疗30d后，两组黄斑中心凹形态基本恢复正常。治疗30d后，大部分患眼荧光素眼底血管造影基本正常，仅8眼有轻度视盘渗漏。

结论：早期大剂量甲基强的松龙冲击治疗VKHS可快速提高患者视力，促进视网膜下液吸收，临床疗效优于地塞米松，而且不良反应少，值得推广。

METHODS: Forty-five patients(90 eyes)from January 2010 to February 2014 with VKHS were enrolled in this retrospective case study. The patients were divided into two groups. Twenty-five patients(50 eyes)in observation group were treated with methylprednisolone(1.0g)for 3 days. Then the methylprednisolone was reduced to 0.5g per day in the fourth and fifth day. Twenty patients(40 eyes)in control group were treated with dexamethasone(12mg)for 5 days. Then 60mg of prednisone were given to all the 45 patients and reduced according to the patients' inflammatory, taken off 5mg every time. When the dose was reduced to 15～20mg, the treatment was sustained for 6mo at least. Then the dose was reduced again till prednisone was taken off. The total course of treatment was more than 9mo. All patients underwent B type ultrasound scan, optical coherence tomography(OCT)and fundus fluorescein angiography(FFA)before and after treatments. The changes were analyzed.

RESULTS: There was no statistical significance on vision between the two groups before treatments. Vision of all patients improved after treatments, and that in observation group(0.44±0.19)were significantly better than that in control group(0.55±0.29)at the fifth day(P<0.05). Fifteen days after treatments, vision in the two groups both improved further, that in observation group(0.32±0.17)were better than that in control group(0.39±0.22)without statistical significance(P>0.05). Thirty days after treatment, vision of the two groups was almost back to normal. According to OCT, 84 eyes(93%)had macular neuroepithelial detachment or serous macular detachment, and height of detachment was 1009.67±319.40 μm in observation group, 1098.13±283.45μm in control group. Five days after treatments, the height of detachment in observation group was 307.79±71.35μm, significantly lower than control group(434.13±88.67μm)(P<0.01). And 15 days after treatments,the subretinal fluid in macular zone was absorbed obviously, the height of detachment was 290.61±52.55μm in observation group and 296.55±61.57μm in control group, the difference was not statistically significant(P>0.05). And 30 days after treatments, the morphology of fovea was almost back to normal. One month after treatments, the FFA results were almost normal, expect 8 eyes had slightly leakage.

CONCLUSION: Large dose of methylprednisolone in early stage can improve the VKH patients' vision and promote the subretinal effusion absorption, which has better clinic effect and less adverse reaction than dexamethasone, is worth spread.