Sainz de la Maza M, Tauber J, Foster C S
Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114.
Ophthalmology. 1988 Apr;95(4):481-6. doi: 10.1016/s0161-6420(88)33162-3.
The authors report the results of their experience with cataract surgery in 20 patients (26 eyes) with biopsy-proven cicatricial pemphigoid. All patients were on systemic immunosuppression at the time of surgery (dapsone, azathioprine, cyclophosphamide, or combinations) and were treated with perioperative oral corticosteroids. Patients were evaluated pre- and postoperatively for conjunctival inflammation, conjunctival cicatrization, degree of keratopathy, and disease stage. No patient progressed in disease stage. Vision improved an average of 3.5 Snellen lines (-3 to +8). Worse outcome was associated with chemotherapy intolerance or the presence of any preoperative conjunctival inflammation. Thirteen patients remained on immunosuppressives for the entire study. Corneal ulcers developed postoperatively in three patients in whom continued immunosuppression was not tolerated. Possible mechanisms for inflammatory exacerbation after surgery are discussed. Results indicate that after successful abolition of all conjunctival inflammation through chemotherapy, cataract surgery may be safely performed in patients with cicatricial pemphigoid.
作者报告了他们对20例（26只眼）经活检证实为瘢痕性类天疱疮患者进行白内障手术的经验结果。所有患者在手术时均接受全身免疫抑制治疗（氨苯砜、硫唑嘌呤、环磷酰胺或联合用药），并在围手术期接受口服皮质类固醇治疗。对患者在术前和术后进行结膜炎症、结膜瘢痕形成、角膜病变程度和疾病分期的评估。没有患者的疾病分期进展。视力平均提高了3.5行斯内伦视力表度数（-3至+8）。较差的结果与化疗不耐受或术前存在任何结膜炎症有关。13例患者在整个研究过程中一直使用免疫抑制剂。3例患者术后出现角膜溃疡，这些患者无法耐受持续的免疫抑制治疗。文中讨论了手术后炎症加重的可能机制。结果表明，在通过化疗成功消除所有结膜炎症后，瘢痕性类天疱疮患者可以安全地进行白内障手术。
