Augsten R, Dawczynski J, Voigt U, Oelzner P, Schulze E, Königsdörffer E
Klinik für Augenheilkunde, Universitätsklinikum Jena, Bachstrasse 18, Jena.
Klin Monbl Augenheilkd. 2011 Jan;228(1):66-9. doi: 10.1055/s-0029-1245122. Epub 2010 Aug 16.
Keratolysis is a rare severe complication following systemic autoimmunologic diseases. Despite of complex therapeutic treatments, the prognosis is very poor.
Ten eyes from seven patients with corneal ulcers were reported (age 45 - 73 years, mean 63 years; 6 women, 1 man). The corneal ulcer was perforated in 7 eyes. Five patients suffered from rheumatoid arthritis, and one patient developed a Sjögren's syndrome. Besides, one patient had shown both autoimmunologic diseases. After clinical attendance, visual acuity in the eyes with nonperforated ulcers was between 0.1 and 0.4, and in the eyes with perforated ulcers between light perception and 0.2.
In 7 eyes with perforated corneal ulcers an emergency tectonic conjunctival plasty and, 1 - 2 days later, a keratoplasty had been performed. Postoperatively, local therapies had been initiated with antibiotic and immunosuppressive eyedrops as well as with conventional drops for dry-eye symptoms. Because of the autoimmunologic diseases of the patients, a systemic immunosuppressive therapy had been arranged. Follow-up period had been between 4 weeks and 3,5 years (mean 16 months). In the three eyes with nonperforated ulcers which received an antibiotic and immunosuppressive treatment, visual acuity was found at 1 / 20 and 0.4. However, in spite of stabilized findings in the 5 eyes with perforated ulcers, the visual acuity was in this case only between light perception and 0.05. One patient with a perforated ulcer and one patient with a recurrent corneal perforation after keratoplasty refused further operative procedures. Finally, both eyes had to undergo evisceration.
Despite of intensive local and systemic immunosuppressive as well as operative therapies, corneal ulcers associated with autoimmunologic diseases (rheumatoid arthritis, Sjögren's syndrome) may cause a marked decrease of visual acuity or the loss of an eye. With regard to the healthy eye, an immunosuppressive therapy for life is most important.
角膜溶解是全身性自身免疫性疾病后一种罕见的严重并发症。尽管进行了复杂的治疗，但预后很差。
报告了7例角膜溃疡患者的10只眼（年龄45 - 73岁，平均63岁；6名女性，1名男性）。7只眼角膜溃疡穿孔。5例患有类风湿性关节炎，1例患有干燥综合征。此外，1例患者同时患有这两种自身免疫性疾病。就诊时，非穿孔性溃疡眼的视力在0.1至0.4之间，穿孔性溃疡眼的视力在光感至0.2之间。
7只穿孔性角膜溃疡眼进行了紧急结膜瓣遮盖术，并在1 - 2天后进行了角膜移植术。术后，开始局部使用抗生素和免疫抑制眼药水以及治疗干眼症状的常规眼药水。由于患者患有自身免疫性疾病，安排了全身免疫抑制治疗。随访期为4周至3.5年（平均16个月）。3只接受抗生素和免疫抑制治疗的非穿孔性溃疡眼的视力为1/20和0.4。然而，尽管5只穿孔性溃疡眼的病情稳定，但此时视力仅在光感至0.05之间。1例穿孔性溃疡患者和1例角膜移植术后角膜反复穿孔患者拒绝进一步手术。最后，两只眼都不得不进行眼内容剜除术。
尽管进行了强化的局部和全身免疫抑制以及手术治疗，但与自身免疫性疾病（类风湿性关节炎、干燥综合征）相关的角膜溃疡可能导致视力显著下降或失明。对于健眼而言，终身免疫抑制治疗至关重要。
