Boston Ⅱ型人工角膜治疗Stevens-Johnson综合征难治性角膜融解穿孔1例  

A case of Stevens-Johnson syndrome with binocular corneal perforation and multiple corneal transplantation which was difficult to control

作　　者：刘晶劼 王丽强[1] 黄一飞[1] 袁进[2] 李赛群[2] Liu Jingjie;Wang Liqiang;Huang Yifei;Yuan Jin;Li Saiqun(The Ophthalmology Division of Chinese PLA General Hospital,Beijing 100853,China;Zhongshan Ophthalmic Centre,Sun Yat-sen University,State Key Laboratory of Ophthalmology,Guangzhou 510060,China)

机构地区：[1]解放军总医院眼科医学部,北京100853 [2]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼科杂志》2022年第8期624-628,共5页Chinese Journal of Ophthalmology

基　　金：北京市临床特色重点项目(Z161100000516012)。

摘　　要：31岁女性因右眼角膜移植术后5个月热泪涌出3 d就诊。患者4年前因盆腔炎性反应静滴头孢呋辛钠及甲硝唑后出现双眼红痛、干涩、畏光,伴有高热及全身皮疹及表皮剥脱,指甲脱落,眼、口腔等多处黏膜溃烂。后患者于当地医院行全身糖皮质激素冲击及局部药物治疗,眼部干燥并逐渐加重,尽管局部给予持续人工泪液及绷带镜等治疗,仍先后发生双眼角膜溃疡穿孔。经多次穿透性角膜移植术和药物治疗无法阻止溃疡和角膜融解,因双眼角膜穿孔入院。眼科检查:右眼视力15 cm手动,眼压中度降低,结膜囊狭窄,角膜广泛混浊水肿,溃疡直径约8 mm,下方近角膜缘约2 mm×5 mm的角膜穿孔。左眼视力无光感,角膜中央溃疡直径约8 mm,后弹力层膨出,无前房,眼球萎缩。B超显示右眼脉络膜脱离。行右眼眼内探查、玻璃体切除、异位角巩膜载体BostonⅡ型人工角膜植入术、青光眼阀植入术、自体耳软骨植入术、结膜遮盖术,左眼板层角膜移植、结膜遮盖术。术后右眼-6.50 DS矫正至0.12,眼压正常,眼表稳定。左眼视力无光感,眼表稳定。The 31-year-old female patient was admitted to the General Hospital of the Chinese People′s Liberation Army for 3 days after the corneal transplantation of her right eye for 5 months.Four years ago,the patient developed red eyes,pain,dryness and photophobia after intravenous drip of cefuroxime sodium and metronidazole due to pelvic inflammation,accompanied by high fever,systemic rash and epidermal exfoliation,fingernail peeling,and mucosal ulceration in the eyes and mouth.Later,the patient received systemic hormone shock and point eye treatment in a local hospital,and the dry eyes gradually worsened.Despite continuous artificial tears and bandage mirror treatment,the corneal ulcer perforation in both eyes still occurred successively.After several penetrating keratografts and drug therapy,the ulcer and dissolution could not be prevented.He was admitted to our hospital due to corneal perforation in both eyes.Ophthalmic examination:visual acuity manual/15 cm in the right eye,intraocular pressure T-2,conjunctival sac stenosis,extensive corneal opacity and edema,ulcer about 8 mm,corneal perforation near the corneal limbus about 2 mm×5 mm below.The left eye had no light perception,a central corneal ulcer of about 8 mm,bulge of the posterior elastic layer,no anterior chamber,and atrophy of the eyeball.B-ultrasound showed choroidal detachment of the right eye.On the second day,the patient received right eye intraocular exploration,vitrectomy,ecotopic keratoscleral carrier BostonⅡartificial keratoplasty,glaucoma valve implantation,autogenous ear cartilage implantation,conjunctival occlusion,and left eye lamellar keratoplasty,conjunctival occlusion.Postoperative visual acuity of right eye was-6.50 DS=0.12,intraocular pressure TN,ocular surface was stable.The left eye has no light perception and the ocular surface is stable.

关 键 词：STEVENS-JOHNSON综合征 角膜穿孔 角膜移植 假体和植入物 

分 类 号：R779.65[医药卫生—眼科]