Ozbek Zeynep, Burakgazi Ahmet Z, Rapuano Christopher J
Cornea Service, Wills Eye Hospital, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
Cornea. 2006 May;25(4):472-3. doi: 10.1097/01.ico.0000178725.04070.87.
This study was designed to report a patient with a vernal shield ulcer that did not respond to medical therapy but healed in 1 week after surgical debridement of the ulcer base.
Case report and literature review.
A 12-year-old girl with a history of asthma and eczema was seen with a 5.7- x 5.7-mm corneal epithelial defect in the right eye. Her uncorrected visual acuity was 20/200 OD and 20/70 OS. Slit-lamp examination revealed giant papillae on the tarsal conjunctivae, diffuse punctate epitheliopathy, and a thick mucoid discharge in both eyes. A diagnosis of vernal keratoconjunctivitis both eyes (OU) with a shield ulcer OD was made and prednisolone 1% was started 4 times per day OD. Topical ofloxacin 0.3% 3 times per day and topical cyclosporine 0.05% every 2 hours were added OD 2 days later. On minimal improvement in the epithelial defect in 1 week, surgical debridement of the ulcer base was performed. The epithelial defect healed smoothly in 1 week with an underlying stromal scar and the uncorrected visual acuity improved to 20/70 OD at 1 month and 20/40 at 10 months.
Corneal shield ulcers and plaques are rare but serious complications of vernal keratoconjunctivitis, which may be unresponsive to standard medical therapy. Surgical debridement is a fast and effective procedure yielding rapid healing of the ulcer and minimizing complications, such as infections.
本研究旨在报告一名患有春季角结膜病变盾形溃疡的患者，该患者对药物治疗无反应，但在溃疡底部进行手术清创后1周内愈合。
病例报告及文献综述。
一名12岁有哮喘和湿疹病史的女孩右眼出现5.7×5.7毫米的角膜上皮缺损。她的右眼裸眼视力为20/200，左眼为20/70。裂隙灯检查显示睑结膜有巨大乳头、弥漫性点状上皮病变，双眼有浓稠的黏液性分泌物。诊断为双眼春季角结膜炎伴右眼盾形溃疡，开始每天4次右眼使用1%泼尼松龙。2天后右眼加用0.3%氧氟沙星滴眼液，每天3次，以及0.05%环孢素滴眼液，每2小时1次。1周后上皮缺损改善甚微，遂对溃疡底部进行手术清创。上皮缺损在1周内顺利愈合，下方有基质瘢痕形成，右眼裸眼视力在1个月时提高到20/70，10个月时提高到20/40。
角膜盾形溃疡和斑块是春季角结膜炎罕见但严重的并发症，可能对标准药物治疗无反应。手术清创是一种快速有效的方法，可使溃疡迅速愈合，并将感染等并发症降至最低。
