Kivelä T, Tervo K, Ravila E, Tarkkanen A, Virtanen I, Tervo T
Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Acta Ophthalmol (Copenh). 1992 Aug;70(4):534-42. doi: 10.1111/j.1755-3768.1992.tb02128.x.
A 63-year-old man, who had for one month been on sulfasalazine therapy, developed general malaise, high fever, severe stomatitis, and bilateral necrotizing pseudomembranous conjunctivitis with corneal erosion, identical to that seen in the Stevens-Johnson syndrome. Topical therapy with antibiotics and aprotinin rapidly healed the corneal surfaces, while densely adherent true membranes developed on the conjunctiva, and were removed surgically several times during the next week. After the acute stage, subtle subepithelial conjunctival scarring, superficial punctate keratitis, dry eye syndrome and fluctuating irregular corneal astigmatism became evident, but good visual acuity, lid function and ocular motility were retained. Histopathologic study of conjunctival membranes from two cases of membranous conjunctivitis revealed polymorphonuclear leukocytes within a matrix composed of fibrin, tenascin and fibronectin. In older membranes, histiocytes were additionally found. Surgical debridement of such membranes removes a substratum of inflammatory debris that is likely to promote secondary infection, fibrosis and symblepharon formation, and may decrease rather than increase subsequent scarring of the necrotized conjunctiva.
一名63岁男性，已接受柳氮磺胺吡啶治疗一个月，出现全身不适、高热、严重口腔炎以及双侧坏死性假膜性结膜炎伴角膜糜烂，与史蒂文斯-约翰逊综合征所见相同。局部使用抗生素和抑肽酶治疗后，角膜表面迅速愈合，而结膜上形成了紧密粘连的真性膜，并在接下来的一周内多次进行手术切除。急性期过后，结膜上皮下出现轻微瘢痕、浅层点状角膜炎、干眼综合征以及波动性不规则角膜散光，但视力、眼睑功能和眼球运动均保持良好。对两例膜性结膜炎患者的结膜膜进行组织病理学研究发现，在由纤维蛋白、腱生蛋白和纤连蛋白组成的基质中有多形核白细胞。在较陈旧的膜中，还发现了组织细胞。对这类膜进行手术清创可去除炎性碎屑基质，而该基质可能会促进继发感染、纤维化和睑球粘连形成，并且可能会减少而非增加坏死结膜随后的瘢痕形成。
