白内障超声乳化吸除术后并发单纯疱疹病毒性角膜炎的特点及治疗  

Clinical characteristics and treatments of herpes simplex keratitis after phacoemulsification

作　　者：孙莉[1] 陈蔚[1] 

机构地区：[1]温州医学院附属眼视光医院,浙江325027

出　　处：《眼科》2013年第3期161-164,共4页Ophthalmology in China

摘　　要：目的观察白内障超声乳化术后并发单纯疱疹病毒性角膜炎（HSK）的临床特点和治疗效果。设计回顾性病例系列。研究对象2005年4月至2012年8月温州医学院附属眼视光医院白内障术后并发HSK患者12例（15眼）。方法对上述患者的资料进行回顾性分析，记录患者基本信息、临床分型（Holland诊断分类法）、手术史、治疗方案和病程。治疗方案：感染性角膜上皮炎给予阿昔洛韦片口服；局部更昔洛韦凝胶；无防腐剂人工泪液滴眼。基质型和内皮型角膜炎予以静脉滴注阿昔洛韦和地塞米松，口服阿昔洛韦片和强的松片；局部滴用0．02％氟美瞳和自体血清。主要指标临床分型、症状、体征、病程。结果12例（15眼）患者均在白内障手术后3天-4周内出现不同程度的角膜病变，其中感染性角膜上皮炎5例（6眼），基质型和内皮型7例（9眼）。所有患者术后均出现不同程度眼红、痛、异物感、畏光流泪和视力下降。治疗后上皮型患者视力从0．3-0．6提高至0．6-0．8，病程1-3周；基质型和内皮型患者视力从手动-0．6提高至指数-0．9，病程1-3个月。结论白内障术后并发HSK尽管比例不高，但容易误诊和漏诊，患者的病程与病情轻重相关，及时正确诊断和治疗对视功能恢复有重要意义。Objective To discuss the clinical characteristics and treatments of herpes simplex keratitis （HSK） after phacoemulsification. Design Retrospective case series. Participants Twelve patients （15 eyes） who presented in Eye Hospital of Wenzhou Medical College with HSK after cataract surgery from April 2005 to August 2012. Method All patients data including demographic informations, clinical classification （Holland diagnostic classification）, history of surgery, treatment protocols and duration, were reviewed retrospectively. Epithelial keratitis were treated with oral acyclovir, ganeiclovir gel and preservative-free artificial tears. The stromal and endothelial keratitis were treated with intravenous aeyclovir and dexamethasone followed by oral acyelovir and prednisone, 0.02% fluoromctholone and topical autohemotherapy. Main Outcome Measures Clinical classification, symptoms, signs and duration of the disease. Results Twelve patients （15 eyes） presented with different stage of HSK between 3 days and 4 weeks after cataract surgery. There were 5 patients（6 eyes） with epithelial keratitis and 7 patients（ 9 eyes）with stromal and endothelial keratitis. All patients presented with redness, pain,foreign body sensation, photophobia, tearing and decreased vision after surgery. Visual acuity of patients with epithelial HSK improved from 0.3-0.6 to 0.6-0.8 after treatment and duration of disease was between 1-3 weeks. In patients with stromal and endothelial HSK, visual acuity improved from hand motion - 0.6 to counting finger - 0.9 after treatment with a duration of disease between 1-3 months. Conclusion Because the prevalence of HSK after cataract surgery is lower, it can be easily misdiagnosed. Duration of HSK after cataract surgery was related to the extent of the corneal lesion. It is important for visual function restoration to diagnose in time and treat adequately in patients with HSK after cataract surgery

关 键 词：白内障 外科学 超声乳化白内障吸除术 单纯疱疹病毒性角膜炎 

分 类 号：R779.66[医药卫生—眼科]