继发性干燥综合征合并角膜缘干细胞功能障碍继发铜绿假单胞菌感染1例  

A case of secondary keratoconjunctivitis sicca with limbal stem cell deficiency complicated by pseudomonas aeruginosa infection

作　　者：乐琦骅 卢楚薇 洪佳旭 LE Qihua;LU Chuwei;HONG Jiaxu(Department of Ophthalmology,Eye&ENT Hospital,Fudan university,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2025年第S1期9-14,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：82岁男性,因“双眼异物感伴黏性分泌物1个月余”于2023年7月27日首诊。外院诊断为“角膜炎,白内障”,给予阿昔洛韦联合左氧氟沙星滴眼液治疗1个月,症状无明显改善。我院专科检查示双眼角膜上皮弥漫性糜烂伴卷丝,4个月后左眼逐渐出现上皮灰白色涡状病变。外院实验室检查提示IFANA抗核抗体1:80阳性,抗双链DNA抗体28 IU/mL。结合眼科临床表现,诊断为双眼继发性干燥综合征,左眼角膜缘干细胞功能障碍(LSCD)。治疗方案:滴用0.1%氟米龙滴眼液(后期改为氯替泼诺)、0.05%他克莫司滴眼液、小牛血清眼膏及无防腐剂人工泪液。随访1年余,患者在维持他克莫司治疗、逐步减停糖皮质激素后,病情总体稳定,但左眼角膜上皮情况较右眼更差。2024年8月20日,患者行右眼白内障手术,术后12 d左眼突发细菌性角膜溃疡(铜绿假单胞菌感染),经及时抗感染治疗后病情好转。讨论体会:重度干眼合并LSCD的患者,眼表炎症和感染风险较高,治疗应注重眼表炎症的控制和感染的预防,巩膜镜(SLs)可作为重度干眼和角膜上皮病变的有效治疗手段。An 82-year-old male presented on July 27,2023 with a chief complaint of“a one-month history of bilateral foreign body sensation and mucoid discharge”.He was previously diagnosed with keratitis and cataracts at another hospital and treated with acyclovir and levofloxacin eye drops,without any improvement.Ophthalmic examinations revealed diffuse corneal epithelial erosion with filaments in both eyes at the first presentation.After four months,a grayish-white whorl-like epithelial lesion gradually developed in his left eye.Laboratory tests showed that the antinuclear antibody was 1:80 positive and the anti-double-stranded DNA antibody was 28 IU/mL.Based on the ophthalmic findings,he was diagnosed with bilaterally secondary keratoconjunctivitis sicca and limbal stem cell deficiency(LSCD)in the left eye.The patient was treated with 0.1%fluorometholone eye drops(later switched to loteprednol),0.05%tacrolimus eye drops,bovine serum ointment,and preservative-free artificial tears.During a one-year follow-up,the patient had a continuous tacrolimus therapy and gradual tapering of corticosteroids although the the epitheliopathy of the left eye was not recovered.On Sept 1st,2024,twelve days after a cataract surgery in his right eye,the left eye developed a severe bacterial corneal ulceration caused by Pseudomonas aeruginosa.With timely antimicrobial therapy,the infection was controlled.Discussion:Patients with severe dry eye and LSCD have an increased risk of ocular surface infection.The management of ocular surface inflammation and the prevention of infections should be emphasized in the treatment.Scleral lenses(SLs)may serve as an effective therapeutic option for severe dry eye and corneal epithelial disorders.

关 键 词：重度干眼 角膜缘干细胞功能障碍 细菌性角膜炎 铜绿假单胞菌 巩膜镜 

分 类 号：R73[医药卫生—肿瘤]