Nguyen Virginia T, Hwang Thomas N, Shamie Neda, Chuck Roy S, McCulley Timothy J
Department of Ophthalmology, University of California, San Francisco, San Francisco, CA 94143, USA.
Cornea. 2009 Jun;28(5):575-6. doi: 10.1097/ICO.0b013e318191bdae.
To describe amyloidosis-associated neurotrophic keratopathy.
In this interventional case report, we describe the clinical findings of a patient with amyloidosis-associated neurotrophic keratopathy, precipitated by exposure from overcorrected blepharoptosis.
A 70-year-old woman with a history of amyloidosis was referred with bilateral eyelid retraction 1 month after levator aponeurosis advancement surgery. Examination demonstrated visual acuities of count-fingers OD and 20/400 OS and severe corneal epithelial irregularity with diffuse fluorescein staining. She had marked eyelid retraction with 5-mm right and 3-mm left superior scleral show and incomplete closure. Corneas were anesthetic, and neurologic examination was notable for peripheral sensory loss. Despite eyelid position normalization, the corneal abnormalities progressed to large epithelial defects refractory to aggressive lubrication, punctal occlusion, bandage contact lenses, extended patching, and ultimately tarsorrhaphy consistent with neurotrophic keratopathy. One year postoperatively, the epithelial disease persists.
Neurotrophic keratopathy can occur in association with amyloidosis and may be precipitated by exposure related to blepharoptosis repair.
描述淀粉样变性相关性神经营养性角膜病变。
在这份介入性病例报告中，我们描述了一名因上睑下垂矫正过度导致暴露而引发淀粉样变性相关性神经营养性角膜病变患者的临床发现。
一名有淀粉样变性病史的70岁女性在提上睑肌腱膜推进手术后1个月因双侧眼睑退缩前来就诊。检查显示右眼视力为眼前指数，左眼视力为20/400，角膜上皮严重不规则，弥漫性荧光素染色。她有明显的眼睑退缩，右眼上巩膜暴露5毫米，左眼上巩膜暴露3毫米，眼睑闭合不全。角膜无感觉，神经学检查显示有周围感觉丧失。尽管眼睑位置恢复正常，但角膜异常进展为大的上皮缺损，对积极的润滑、泪点封闭、绷带式隐形眼镜、延长包扎治疗均无效，最终睑裂缝合，符合神经营养性角膜病变。术后一年，上皮病变仍然存在。
神经营养性角膜病变可与淀粉样变性相关，并可能由上睑下垂修复相关的暴露引发。
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