人工晶状体置换术后手术诱发坏死性巩膜炎。

Pablo González de Los Mártires, Gonzalo Guerrero Pérez, Iñigo Les Bujanda, Iñaki Elejalde Guerra, Henar Heras Mulero, Esther Compains Silva
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引用次数: 0

摘要

目的:报告一例手术引起的坏死性巩膜炎及其内科和外科治疗。方法:病例报告。结果:患者88岁,单眼左眼严重疼痛3天。6个月前进行了一次性手术,包括PPV和脱位人工晶状体的移除和虹膜爪Artisan®晶状体的二次植入。视力20/100。裂隙灯检查示5 × 2 mm非化脓性巩膜上缺损。开始地塞米松外用经验性抗生素治疗,同时口服强力霉素。排除了传染性和自身免疫性疾病。非感染性巩膜炎治疗采用静脉注射甲基强的松3天脉冲治疗,随后每周使用逐渐减少的强的松和肌注甲氨蝶呤。但诊断后1个月,缺损加重;因此,进行了异种巩膜补片移植,并在干预后几天开始使用阿达木单抗。到目前为止,6个月后,仍然使用适当的巩膜贴片,每日低剂量强的松和间隔阿达木单抗治疗。结论:手术引起的坏死性巩膜炎是一种严重的损害眼睛和视觉完整性的疾病。正确的诊断和早期治疗是实现缓解、防止复发和避免结构性并发症的必要条件。在难治性病例中,抗肿瘤坏死因子-α免疫治疗联合外科构造移植干预可以取得很好的效果。
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Surgical induced necrotizing scleritis following intraocular lens replacement.

Purpose: To report a surgical-induced necrotizing scleritis, as well as its medical and surgical management.

Methods: Case-report.

Results: An 88 year-old patient with a three-day severe single-left-eye ocular pain. One-time surgery involving PPV with removal of dislocated intraocular lens and secondary implantation of iris-claw Artisan® lens was performed 6 months earlier. Visual acuity of 20/100. Slit-lamp examination revealed a 5 × 2 mm non-suppurative superior scleral defect. Empirical topical antibiotic treatment with dexamethasone, as well as oral doxycycline was started. Infectious and autoimmune diseases were ruled out. Non-infectious scleritis treatment was conducted with intravenous Methylprednisolone 3 day pulses, followed by weekly tapered Prednisone and intramuscular Methotrexate. However, 1 month after the diagnosis, the defect was worsened; hence, a heterologous scleral patch graft was performed and, days after the intervention, Adalimumab was initiated. To date, 6 months later, remains with proper scleral patch, a diary low-dose Prednisone, and spacing Adalimumab treatment.

Conclusion: Surgery-induced necrotizing scleritis is a severe condition that compromise the ocular and visual integrity. Proper diagnosis, as well as early treatment is required to achieve remission, prevent relapses, and avoid structural complications. In refractory cases, anti-TNF-α immunotherapy associated with surgical tectonic graft interventions can achieve promising results.

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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
期刊最新文献
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