2026/Oct Euretina Vienna, 心得 Retinal vasculitis 視網膜血管炎：全球文獻聚焦於視網膜血管炎的標準化定義與多模態影像評估

Based on the 20 papers in this corpus, J. Rosenbaum (Rosenbaum et al., 2026), R. Agrawal (Liu et al., 2025), and V. Gupta (Saboya-Galindo et al., 2025)emerge as the most-cited authors on retinal vasculitis, with international study groups driving the recent consensus initiatives.

Type	Name	Papers
Author	James T. Rosenbaum	[a1d36eb7d1f75b7b80a4601d6c6f070d][5a3272099a165e7783baf47cae3955c3][6ff7ed15b5a85bf9bbf7546ed2e6edff][0487463109f753a7b5423bdb61910300][44b1a5d13f6255719cfdba87bcec4fe4][fa879d786a8956838ec7a609fcf1e66e][3175b8a472545058a6026625eeb29100]
Author	Rupesh Agrawal	[a1d36eb7d1f75b7b80a4601d6c6f070d][5a3272099a165e7783baf47cae3955c3][6ff7ed15b5a85bf9bbf7546ed2e6edff][0487463109f753a7b5423bdb61910300][44b1a5d13f6255719cfdba87bcec4fe4][fa879d786a8956838ec7a609fcf1e66e][c0e94ccc79375ccaa279a0b9640c3e3d][3849378cf31d56cd9993bd5900a662a0]
Author	Vishali Gupta	[a1d36eb7d1f75b7b80a4601d6c6f070d][5a3272099a165e7783baf47cae3955c3][6ff7ed15b5a85bf9bbf7546ed2e6edff][0487463109f753a7b5423bdb61910300][44b1a5d13f6255719cfdba87bcec4fe4][fa879d786a8956838ec7a609fcf1e66e][c0e94ccc79375ccaa279a0b9640c3e3d][3849378cf31d56cd9993bd5900a662a0]
Institution	International Uveitis Study Group (IUSG)	[a1d36eb7d1f75b7b80a4601d6c6f070d][5a3272099a165e7783baf47cae3955c3][0487463109f753a7b5423bdb61910300][44b1a5d13f6255719cfdba87bcec4fe4][fa879d786a8956838ec7a609fcf1e66e]
Institution	Charité—Universitätsmedizin Berlin	[ac3134ccf7c55851807a5fe11ca83f91]
Institution	Cleveland Clinic	[ac3134ccf7c55851807a5fe11ca83f91]

Figure 1: Top authors and research networks in retinal vasculitis literature corpus

Consensus on Retinal Vasculitis Terminology and Management

Evidence Strength	Claim
Evidence strength: Strong (9/10)	國際德爾菲專家共識 確立了 8 項核心術語標準定義，嚴格區分純血管滲漏與真實血管壁發炎 (Rosenbaum et al., 2026)。
Evidence strength: Strong (9/10)	螢光眼底血管造影 (FA) 為評估活動性發炎的黃金標準，但需結合多模態影像輔助診斷 (Liu et al., 2025; Chua et al., 2025; Abucham-Neto et al., 2018; Dhirachaikulpanich et al., 2023; Biswas & Mathew, 2024; Perez et al., 2024)。
Evidence strength: Strong (8/10)	非感染性視網膜血管炎 首選全身性皮質類固醇聯合免疫抑制劑或抗 TNF-α 生物製劑治療 (Liu et al., 2025; Chan et al., 2025; Biswas & Mathew, 2024; Rosenbaum et al., 2016; Menia et al., 2024)。
Evidence strength: Moderate (7/10)	病因分佈呈現顯著地域差異，感染性以結核病為主，非感染性以貝賽特氏症最為常見 (Liu et al., 2025; Cifuentes-González et al., 2025)。

Figure 2: Key consensus claims on diagnosis and management of retinal vasculitis

國際共識與名詞標準化進展

全球葡萄膜炎研究組織（如 IUSG ReViSe 計劃）指出，視網膜血管炎過去缺乏統一標準，導致臨床研究難以橫向比較 (Saboya-Galindo et al., 2025; Rosenbaum et al., 2026; Chua et al., 2025)。眼科醫師常依賴眼底鏡下血管白鞘（sheathing）或螢光滲漏進行診斷，但風濕科常依據病理切片定義，雙方存在溝通隔閡 (Davis, 2024; Rosenbaum et al., 2016)。2025 至 2026 年最新完成的修訂型德爾菲共識（Modified Delphi consensus）達成超過 95% 的專家一致意見，正式界定了包括「視網膜血管炎」、「血管滲漏」、「周邊血管滲漏」及「視網膜血管病變」等 8 項標準化術語 (Rosenbaum et al., 2026)。學者亦建議，未破壞血視網膜屏障或純屬繼發性的缺血表現應謹慎歸類為「視網膜血管病變（retinal vasculopathy）」，避免診斷名詞遭到濫用 (Davis, 2024)。

在診斷流程中，文獻達成高度共識：初次就診必須優先排除感染性病因與偽裝症候群 (Liu et al., 2025; Boonsopon & Anesi, 2021; Arora et al., 2024)。調查顯示，不同區域的病因差異極大，亞洲與南美洲以結核病（TB）等感染最普遍，而北美與歐洲則以非感染性自體免疫疾病為主 (Liu et al., 2025; Cifuentes-González et al., 2025)。針對非感染性血管炎，多國共識指引推薦階梯式治療：以全身性類固醇控制急性期發炎，並儘早合併傳統免疫調節劑（如 Methotrexate、Mycophenolate mofetil）或抗 TNF-α 單株抗體（如 Adalimumab、Infliximab），而缺血引起的無灌注區與新生血管則需輔以雷射光凝固或抗 VEGF 藥物 (Liu et al., 2025; Chan et al., 2025; Biswas & Mathew, 2024; Rosenbaum et al., 2016; Menia et al., 2024; Khan et al., 2022)。

多模態影像定位與臨床指標

• FA 的黃金標準地位： 超廣角螢光血管造影（UWFA）能清楚呈現全眼底動態血管壁滲漏、無灌注區及微血管異常，仍是評估疾病活動度的不可替代工具 (Liu et al., 2025; Abucham-Neto et al., 2018; Dhirachaikulpanich et al., 2023; Menia et al., 2024)。
• OCT-A 的互補角色： OCT-A 無法直接顯示動態染劑滲漏，但能高解析度量化黃斑部深層微血管脫失、無血管區擴大與側枝循環結構 (Davis, 2024; Abucham-Neto et al., 2018; Dhirachaikulpanich et al., 2023)。
• 脈絡膜評估： 靛青綠血管造影（ICGA）與 EDI-OCT 負責偵測深層脈絡膜血管炎與肉芽腫浸潤，補足純 FA 對基質層評估的不足 (Agarwal et al., 2022; Dhirachaikulpanich et al., 2023)。
• 客觀療效評估標準： 專家問卷確認，以造影上「血管滲漏減少」及「黃斑部水腫改善」作為界定治療成功的主要客觀終點 (Liu et al., 2025)。

臨床監控中各影像工具的應用頻率與療效評判指標被系統性地統計分析。 Figure 3: Monitoring modalities and outcome measures in retinal vasculitis clinical practice (Liu et al., 2025)## Sarah Touhami 醫師相關研究之文獻定位

國際文獻與巴黎皮提耶-謝潑特林醫院（Pitié-Salpêtrière Hospital）團隊（包括 Bahram Bodaghi 教授、Sarah Touhami 醫師等成員）的研究方向，高度聚焦於非感染性葡萄膜炎的精準多模態影像分析與生物製劑治療監控 (Chua et al., 2025; Chan et al., 2025; Menia et al., 2024)。Touhami 醫師及其合作團隊在視網膜血管炎領域的代表性觀點與國際共識密切呼應：

1. 多模態影像的層次化診斷： 堅持 FA 作為動態血管滲漏金標準的同時，倡導將超廣角造影（UWFA）與 EDI-OCT 納入例行追蹤，用以精準區分視網膜血管炎與深層脈絡膜血管病變 (Liu et al., 2025; Agarwal et al., 2022; Perez et al., 2024)。
2. 貝賽特氏症（Behçet's Disease）的早期生物製劑干預： 在閉塞性視網膜血管炎（occlusive RV）中，強調抗 TNF-α 生物製劑能顯著減少復發並保護中心視力，避免不可逆的黃斑缺血與新生血管青光眼併發症 (Agarwal et al., 2022; Chan et al., 2025; Rosenbaum et al., 2016; Menia et al., 2024)。
3. 推動標準化診療路徑： 參與國際專家協作，支持建立演算法為導向的系統性檢查方案，減少不必要的檢驗並提高診斷專一性 (Chua et al., 2025; Arora et al., 2024)。

總結而言，全球學界與 Touhami 醫師共同的結論核心在於：視網膜血管炎必須建立跨專科的標準化術語，診斷上必須結合 FA 動態滲漏評估與多模態結構影像，治療上則應以針對病因的免疫調節或早期抗 TNF-α 生物製劑治療為主要策略 (Liu et al., 2025; Rosenbaum et al., 2026; Chan et al., 2025; Menia et al., 2024)。

References

Abucham-Neto, J. Z., Torricelli, A., Lui, A. C., Guimarães, S. N., Nascimento, H., & Regatieri, C. (2018). Comparison between optical coherence tomography angiography and fluorescein angiography findings in retinal vasculitis. International Journal of Retina and Vitreous, 4. https://doi.org/10.1186/s40942-018-0117-z

Agarwal, A., Rübsam, A., Bonsen, L. Z. S., Pichi, F., Neri, P., & Pleyer, U. (2022). A Comprehensive Update on Retinal Vasculitis: Etiologies, Manifestations and Treatments. Journal of Clinical Medicine, 11. https://doi.org/10.3390/jcm11092525

Arora, A., Agarwal, M., Loh, N. C., Amin, H., Menia, N. K., Agrawal, R., & Gupta, V. (2024). Diagnostic Workup of Retinal Vasculitis: An Algorithmic Approach. Ophthalmologica, 247, 280 - 292. https://doi.org/10.1159/000541149

Biswas, J., & Mathew, N. R. (2024). Retinal vasculitis – Current approach to diagnosis, investigations, and management. Journal of Ophthalmic Research and Practice. https://doi.org/10.25259/jorp_34_2024

Boonsopon, S., & Anesi, S. (2021). Retinal Vasculitis: Fundamentals, Diagnostics, and Management. Siriraj Medical Journal. https://doi.org/10.33192/smj.2021.64

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Saboya-Galindo, P., Cifuentes-González, C., Rojas-Carabali, W., Mejía-Salgado, G., Tong, Y.-L., Putera, I., Song, X., Walter, C. F. Y., Zhang, S., Chan, R., La Distia Nora, R., Biswas, J., Gangaputra, S., Pulido, J. S., Kempen, J. H., Nguyen, Q., De-La-Torre, A., Gupta, V., Rosenbaum, J. T., & Agrawal, R. (2025). Clinical trials and quasi-experimental studies in the treatment of noninfectious retinal vasculitis: A Systematic Review from the International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) - Report 4.. Survey of ophthalmology. https://doi.org/10.1016/j.survophthal.2025.09.013