摘要
目的分析超声乳化白内障术后病毒性角膜内皮炎临床特征及疗效。方法对2015年3月至2019年3月在乐山市眼科中心诊治最终确诊为角膜内皮炎的13病例进行回顾性分析,分别记录其裂隙灯显微镜下角膜水肿范围、内皮KP情况、眼压、视力、激光共聚焦显微镜(Confocal)下内皮细胞形态、数量及KP情况,分析其临床特征,误诊原因及最终治疗转归。结果裂隙灯下见角膜局限性或弥漫性水肿,水肿消退后可査见病变区KP聚集。Confocal下水肿对应角膜内皮面较多炎性细胞浸润,内皮细胞混浊、肿胀,形态不规则,失去正常六边形结构,六边形细胞的百分比及密度下降,边界模糊,细胞核增大,可见大小不一,形态各异的高反光KP,呈散在分布,聚集成团或条索状分布。严重角膜水肿区无法窥清内皮结构,可见高反光团。应用抗病毒联合糖皮质激素治疗一周后,水肿消退,KP部分吸收,视力较前提高。病情稳定后,内皮细胞丢失率(12.3%)。结论白内障术后角膜水肿及内皮KP要优先考虑病毒性内皮炎可能,掌握其临床特征,有助于诊断和治疗。
Objective To analyze the clinical characteristics and efficacy of viral keratoendothelitis after phacoemulsification cataract surgery.Methods A retrospective analysis was made on 13 cases of corneal endothelitis diagnosed and treated in Leshan Ophthalmological Center from March 2015 to March 2019.The range of corneal edema,endothelial KP,intraocular pressure,visual acuity,endothelial cell morphology,quantity and KP under laser confocal microscopy were recorded under slit lamp microscopy,and their clinical characteristics»causes of misdiagnosis and final treatment were analyzed.Results Localized or diffuse corneal edema was seen under slit lamp,and KP aggregation in lesion area could be seen after edema subsided.Confocal hypoedema corresponds to more inflammatory cells infiltration on corneal endothelial surface,endothelial cells are cloudy,swollen,irregular in shape,loss of normal hexagonal structure,decrease in percentage and density of hexagonal cells»blurred in boundary,enlargement of nucleus,visible in different sizes and shapes of high-reflective KP,which are scattered,clustered or banded.In severe corneal edema,the endothelial structure can not be seen clearly,and high reflective mass can be seen.After one week of treatment with antiviral therapy combined with glucocorticoid,edema subsided,KP partially absorbed,and visual acuity improved.Loss rate of endothelial cells after stabilization.Conclusion Corneal edema and endothelial KP after cataract surgery should give priority to the possibility of viral endothelitis.It is helpful for diagnosis and treatment to master its clinical features.
作者
卢建群
毕娟
罗静
杜慧斌
Lu Jianqun;Bi Juan;Luo Jing;Du Huibing(Leshan People's Hospital of Ophthalmology,Leshan,Sichuan,614000)
出处
《中医眼耳鼻喉杂志》
2019年第3期146-148,共3页
Journal of Chinese Ophthalmology and Otorhinolaryngology
关键词
白内障术后
角膜内皮炎
裂隙灯显微镜
共聚焦显微镜
Postoperative cataract surgery
Corneal endotheiitis
Silt lamp miccroscope
Confocal microscope
