迟发性、散发性眼前节毒性综合征临床分析  

Clinical analysis of sporadically delayedoneset toxic anterior segment syndrome

作　　者：张唯伟[1] 姬红培[1] 

机构地区：[1]贵州省人民医院眼科,贵州省贵阳市550002

出　　处：《眼科新进展》2014年第10期954-955,958,共3页Recent Advances in Ophthalmology

基　　金：贵州省科学技术基金资助(编号:2007-2114)~~

摘　　要：目的 探讨散发性、迟发性眼前节毒性综合征（ｔｏｘｉｃ ａｎｔｅｒｉｏｒ ｓｅｇｍｅｎｔ ｓｙｎｄｒｏｍｅ，ＴＡＳＳ）的发病原因、临床表现、治疗方法及预后。方法 回顾性分析我院２０１１年３月至２０１３年９月治疗的散发性、迟发性ＴＡＳＳ１０例患者的临床资料。结果 手术方式：白内障超声乳化吸出联合人工晶状体植入术８例，白内障皮质抽吸联合人工晶状体植入术２例。发病原因：人工晶状体源性５例，前房纤维性异物１例，无明显原因４例。ＴＡＳＳ发生时间为术后（６．０±０．４）ｄ，其中术后４ｄ者１例，５～７ｄ者７例，＞７ｄ者２例。临床表现：１例中度、９例重度，其中２例患儿前房内纤维素渗出明显较成人严重。治疗：轻度采用妥布霉素地塞米松眼液滴眼，每２ｈ１次，妥布霉素地塞米松眼膏涂眼；中度和重度：结膜下注射地塞米松２ｍｇ，每天１次，连续３～５ｄ，复方托吡卡胺散瞳，每天３次，必要时加用散瞳合剂，余治疗同轻度。治疗３ｄ后症状不能缓解者全身加用类固醇激素。治疗后随访１个月～１ａ，所有患者经治疗后前房内炎症反应消退、纤维素渗出吸收，角膜恢复透明，但瞳孔散大，光反射消失；２例患儿后发性白内障形成。术后３个月经Ｎｄ：ＹＡＧ激光后囊膜切开术后视力提高，但存在畏光、眩光等并发症。结论 散发性、迟发性ＴＡＳＳ可能与人工晶状体类型、进入眼内的异物有关，但也可能存在个体差异。Objective To investigate the etiology,clinical features,treatment and prognosis of sporadically delayed-oneset toxic anterior segment syndrome （TASS）. Methods The clinical data of 10 definitely diagnosed sporadically delayed-oneset TASS cases were retrospectively analyzed. Results Among 10 TASS cases,8 cases underwent routine phacoemulsificatinn and implantation of foldable intraocular lens ,2 cases underwent routine irrigation/aspiration and implantation of foldable IOL. Five cases were caused by intraocular lens implanted, 1 case resulted from a white single cotton fiber strayed into anterior chamber, and 4 cases were for no definite reason. The TASS cases occurred at 4 days （ 1 case）, 5 - 7 days （7 cases）, 〉 7 days （2 cases） postoperatively,the mean time for TASS was （6.0 ± 0.4） days. The severity of the inflammatory reaction was moderate in 1 case, severe in 9 cases, among which two children were more severely. Tobramycin and dexamethasone eye drops （ one time per 2 hours） and ointment （one time per night） were used for all cases. For moderate and severe cases,2 mg dexamethasone sodium phosphate subconjunctival injection continued to 3 - 5 days （ each time per day）. After treatment for 3 days,intravenous or oral corticosteroid was administrated if the inflammation in the anterior chamber didn＇ t subside. At the end of 1 - 12 months follow-up, corneal edema was resolved and signs of anterior segment inflammation were disappeared in terms of all cases, but with poorly reactive and dilated pupil. Two children had posterior capsular opacification and were treated with a neodymium： YAG capsulotomy at 3 months postoperatively, the visions were improved, but complaining for glare and photophobia. Conclusion Sporadically delayed-oneset TASS may be related with the type of intraocular lens and sterile/stable substances strayed into an- terior chamber, it mav have individual differences.

关 键 词：眼前节毒性综合征 迟发性 散发性 炎症反应 白内障 

分 类 号：R770.4[医药卫生—眼科]