南京“5．7”^192Ir源放射事故患者眼晶状体和眼底的改变  

Changes of ocular lens and fundus in patient after exposure to ^192Ir at ＂5.7＂ accident in Nanjing

作　　者：徐国旭[1] 娄慧[1] 曾欣蔚 王优优[2] 刘玉龙[2] 

机构地区：[1]苏州大学附属第二医院眼科,215004 [2]苏州大学附属第二医院应急中心,215004

出　　处：《中华放射医学与防护杂志》2016年第5期364-367,共4页Chinese Journal of Radiological Medicine and Protection

基　　金：江苏省临床医学科技专项（BL2014040）;江苏省卫生计生委2014-2015年度预防医学科研项目（Y2015024）

摘　　要：目的 根据对1例意外受到192Ir源外照射患者的眼晶状体和视网膜改变的动态随访观察,总结放射性损伤所致相关眼晶状体及视网膜改变的特点,为临床核事故患者的眼科诊治和预后判断提供客观的诊断经验和依据。方法 对患者的眼晶状体和视网膜进行视力、裂隙灯、自动视野分析仪、眼底光学相干断层（OCT）扫描、眼底照相、眼底血管造影等形态功能检查,并密切坚持随访20个月,对检查结果进行对比分析。结果 患者在受辐射后1个月首诊时,双眼视力均为1.0,眼晶状体周边皮质轻微老年性浑浊性变化,眼底未见异常。20个月后随访检查,视力下降（约0.6）,右眼晶状体皮质区可见明显粉末状和点状浑浊,后极区后囊及其下亦出现轻微局限浑浊灶;右眼视野颞上方缺损及鼻下方出现局部暗点;黄斑部中心凹厚度变化不大,眼底检查及造影和OCT扫描均证明和提示双眼已有视神经部分轻度萎缩改变,双眼玻璃膜疣,视盘颜色较淡,双眼眼底造影可见点状或絮状渗漏。结论 放射性辐射可以引起或加重眼晶状体浑浊,其形态特征可以不限于后囊下及后极区白内障,也可以是在皮质层内形成非冠状分布的点状浑浊。此外,视网膜和视神经也可以发生损伤。值得注意的是,即使受辐射后早期眼部检查正常,后期也会出现这些病理改变。Objective To make a summary of radiation-induced changes in ocular lens and retinal lesions based on dynamic follow-up of a patient exposed to a radiation exposure from 192Ir source accident, in order to provide the information and experience for the clinical diagnosis and treatment of such injury in emergency of a nuclear or radiation accident.Methods The examination methods included eye lens and visual acuity, slit-lamp examination, fundus examination, automated perimetry, optical coherence tomography （OCT） examination, fundus photography, and fundus fluorescein angiography （FFA）. The patient was followed-up for 20 months. Comparative analyses were made of the follow-up results. Results One month after 192Ir radiation exposure, the visual acuities in both eyes were 1.0. Mild age-related opacities were observed in peripheral cortex, but the fundus looked normal. Twenty months later, the patient was followed-up. The visual acuities reduced to about 0.6, evident powder- and punctuate-like opacities could be observed in the cortex of the right lens, and mild turbid foci in the posterior polar and capsule. Multiple scotomata appeared in the superior temporal and inferior nasal in the right eye. The macular fovea thickness was not changed significantly in the right eye. Examination with fundus photography demonstrated mild optical nerve atrophy, drusens, and pale optic discs, while FFA examination showed punctuate or flocculent leakages in both eyes. Conclusions The lens opacity could be induced or accelerated by radiation exposure. In addition to the posterior capsule and pole cataracts, punctuate opacity within cortical layer may also occur. It also suggests that cataract and fundus injuries may occur later during long-term follow-up, even though the eyes may look normal during early examination after the patient exposed to the radiation.

关 键 词：^192IR 骨髓型急性放射病 眼晶状体 视网膜 医学随访 

分 类 号：R818[医药卫生—放射医学]