Farooq Asim V, Gibbons Allister G, Council Matthew D, Harocopos George J, Holland Simon, Judelson Jeffrey, Shoss Bradley L, Schmidt Eric J, Md Noh Umi Kalthum, D'Angelo Alexander, Chundury Rao V, Judelson Richard, Perez Victor L, Huang Andrew J W
Departments of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri.
Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
Am J Ophthalmol. 2017 Feb;174:119-125. doi: 10.1016/j.ajo.2016.10.007. Epub 2016 Oct 25.
To report a series of patients who developed corneal toxicity after exposure to aquarium coral palytoxin.
Multicenter retrospective case series.
Retrospective review.
Seven patients presented with corneal findings ranging from superficial punctate epitheliopathy to bilateral corneal melt with subsequent perforation. Among those with mild corneal findings, resolution was achieved with topical steroids and lubrication, whereas some patients who developed progressive corneal melt required therapeutic penetrating keratoplasty. The history in all patients revealed exposure to aquarium zoanthid corals shortly before disease onset. A review of the literature revealed that there are few prior reports of coral-associated corneal toxicity and that some species of coral secrete a substance known as palytoxin, a potent vasoconstrictor that inhibits the membranous sodium-potassium ATPase pump across cell types and can cause rapid death if inhaled or ingested.
This is the largest case series to date demonstrating patients with aquarium coral palytoxin-associated corneal toxicity, and is the first to provide details of related histopathologic findings. Similar to other forms of toxic keratoconjunctivitis, a detailed history and careful clinical assessment are required, as well as timely removal of the offending agent from the patients' ocular milieu and environment. Mild ocular surface and corneal disease may be treated effectively with aggressive topical steroid therapy and lubrication. Given the potential severity of ocular as well as systemic adverse effects, there should be increased awareness of this entity among eye care professionals, aquarium enthusiasts, and the general public.
报告一系列接触水族箱珊瑚多环裸甲藻毒素后发生角膜毒性的患者。
多中心回顾性病例系列。
回顾性研究。
7例患者出现的角膜表现从浅层点状上皮病变到双侧角膜溶解并随后穿孔不等。在那些角膜表现较轻的患者中，局部使用类固醇和润滑治疗后病情缓解，而一些发生进行性角膜溶解的患者需要进行穿透性角膜移植治疗。所有患者的病史均显示在疾病发作前不久接触过水族箱中的纽扣珊瑚。文献回顾显示，此前关于珊瑚相关角膜毒性的报道很少，并且某些种类的珊瑚会分泌一种名为多环裸甲藻毒素的物质，这是一种强效血管收缩剂，可抑制跨细胞类型的膜钠钾ATP酶泵，如果吸入或摄入可导致迅速死亡。
这是迄今为止最大的一组证明水族箱珊瑚多环裸甲藻毒素相关角膜毒性患者的病例系列，也是第一个提供相关组织病理学发现细节的病例系列。与其他形式的中毒性角结膜炎一样，需要详细的病史和仔细的临床评估，以及及时从患者的眼内环境和环境中去除致病因素。轻度眼表和角膜疾病可通过积极的局部类固醇治疗和润滑有效治疗。鉴于眼部以及全身不良反应的潜在严重性，眼科护理专业人员、水族爱好者和普通公众对该疾病的认识应有所提高。
