Perez Victor L, Azar Dimitri T, Foster C Stephen
The Ocular Immunology and Uveitis and Cornea/External Diseases Departments, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA.
Semin Ophthalmol. 2002 Sep-Dec;17(3-4):124-30. doi: 10.1076/soph.17.3.124.14786.
The onset of post-operative corneal melting and necrotizing scleritis in patients with rheumatoid arthritis and collagen vascular disease who undergo cataract surgery can have devastating ocular and systemic consequences. Even though ocular surface factors such as sicca and surgical trauma are among the important variables that contribute to this entities, signs and symptoms of systemic disease need to be thoroughly investigated in order to prevent life-threatening complications associated with these ocular manifestations. The management of surgical induced corneal melting and necrotizing scleritis in these patients, include local therapy and in most instances, systemic immuno-modulation. Moreover, the development of corneal melting and necrotizing scleritis in an otherwise "healthy" patient after uncomplicated cataract surgery, can be the first manifestation of a serious occult systemic disease. Therefore, an aggressive approach regarding the diagnosis, workup and treatment should be initiated by the ophthalmologist in order to maximize a successful ophthalmic and medical outcome.
类风湿关节炎和胶原血管病患者接受白内障手术后发生的术后角膜溶解和坏死性巩膜炎，可能会产生毁灭性的眼部和全身后果。尽管眼表因素如干燥症和手术创伤是导致这些病症的重要变量，但仍需全面调查全身疾病的体征和症状，以预防与这些眼部表现相关的危及生命的并发症。这些患者手术诱发的角膜溶解和坏死性巩膜炎的治疗包括局部治疗，在大多数情况下还包括全身免疫调节。此外，在无并发症的白内障手术后，原本“健康”的患者发生角膜溶解和坏死性巩膜炎，可能是严重隐匿性全身疾病的首发表现。因此，眼科医生应采取积极的诊断、检查和治疗方法，以最大限度地提高眼科和医学治疗的成功率。
