双侧周围性溃疡性角膜炎1例

Belghmaidi Sarah, Darfaoui Zineb, Hajji Ibtissam, Moutaouakil Abdeljalil
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摘要

外周性溃疡性角膜炎(PUK)是一种侵袭性的,潜在的视力威胁的外周角膜变薄的原因。它可能先于全身性疾病的诊断,因此这些病例需要紧急调查。43岁女性,双侧流泪,眼部疼痛持续7个月。双眼视力均为6/6。生物显微镜检查发现月牙形角膜溃疡伴病灶周围模糊。泪膜研究显示Schirmer试验结果(双眼5mm)和泪膜破裂时间(双眼5秒)减少。询问和病人透露,他有反复出现的皮肤病变,在双腿慢性瘙痒,和反复出现的口腔和生殖器溃疡自愈。提出了白塞病的诊断方法。病理检查阴性,HLA B51阳性。全身治疗以秋水仙碱开始,剂量为2mg/天。继续滴眼液和全身强的松龙剂量为1mg/kg/天,并逐渐减少。随访3个月和6个月均未见双眼溃疡复发。白塞氏病很少有角膜表现的报道。眼内前后段合并炎症是眼部白塞病最常见的特征。眼科全身性疾病患者与内科医生的协作管理可改善整体预后,并预防此类患者的发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Case of Bilateral Peripheral Ulcerative Keratitis
Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It may precede the diagnosis of the systemic condition and therefore these cases require urgent investigation. A 43-year-old woman presented with bilateral tearing and ocular pain persisting for 7 months. Visual acuity was 6/6 in both eyes. On biomicroscopic examination, presence of crescent shaped corneal ulcer with perilesional haziness. A tear film study demonstrated decreased Schirmer test results (5mm in both eyes) and tear film break-up time (5 sec in both eyes). The interrogation and the patient revealed he had recurrent skin lesions in both legs with chronic itching, and recurrent oral and genital ulcers healing spontaneously. The diagnosis of Behcet disease was proposed. Pathergy test was negative, HLA B51 was positif. Systemic therapy was started with colchicine at a dose of 2mg/day. Eye drops and systemic prednisolone at 1mg/kg/day was continued with progressive decrease. The follow up at 3 months and 6 months showed no signs of recurrence of ulceration in both eyes. Corneal manifestation has rarely been reported in Behcet’s disease. Combined intraocular anterior and posterior segment inflammation are most common features of ocular Behcet disease. Collaborative management of ophthalmic patients having systemic illness along with internists improves overall outcomes and prevents morbidity in such patients.
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