Inoue Saki, Imai Hisanori, Tetsumoto Akira, Otsuka Keiko, Nakamura Makoto
Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan.
Case Rep Ophthalmol. 2020 Aug 6;11(2):436-441. doi: 10.1159/000508913. eCollection 2020 May-Aug.
We experienced a rare case of lens-induced uveitis (LIU) with severe proliferative vitreoretinopathy (PVR) diagnosed upon finding lens nuclear material encapsulated by intravitreal proliferative tissue. A 60-year-old man was referred to our hospital for the treatment of vision loss caused by unexplained uveitis in the right eye (OD). Seven months previously, a complicated cataract surgery that required unplanned anterior vitrectomy and transscleral suture of intraocular lens was performed on that eye at another clinic. Severe inflammation with dense vitreous opacity occurred in the OD postoperatively. Although topical and oral administration of steroids reduced the inflammation 7 months after the surgery, PVR with tractional retinal detachment was developed in the OD. Pars plana vitrectomy (PPV) was performed for the treatment and diagnosis. PPV revealed the presence of lens nuclear fragments within the vitreous, which was approximately 60% the ordinary nucleus size and was encapsulated by intravitreal proliferative tissue. The nuclear fragments were extracted from a superior corneoscleral flap. Intraocular inflammation was reduced with postoperative topical and oral steroid treatments and the retina remained reattached 1 year after the PPV. In conclusion, uveitis with an episode of a complicated cataract surgery may suggest LIU.
我们遇到了一例罕见的晶状体诱导性葡萄膜炎(LIU)合并严重增生性玻璃体视网膜病变(PVR)的病例,通过发现玻璃体内增生组织包裹着晶状体核物质得以确诊。一名60岁男性因右眼(OD)不明原因葡萄膜炎导致视力丧失被转诊至我院。七个月前,该眼在另一家诊所接受了复杂的白内障手术,术中需要进行计划外的前部玻璃体切除术和人工晶状体的巩膜外缝合。术后右眼出现严重炎症并伴有致密的玻璃体混浊。尽管术后7个月局部和口服类固醇药物减轻了炎症,但右眼仍发生了伴有牵引性视网膜脱离的PVR。为了治疗和诊断进行了玻璃体切除术(PPV)。PPV显示玻璃体内存在晶状体核碎片,其大小约为正常晶状体核的60%,并被玻璃体内增生组织包裹。从上方角膜缘瓣取出核碎片。术后局部和口服类固醇治疗减轻了眼内炎症,PPV术后1年视网膜仍保持复位。总之,复杂白内障手术后发生的葡萄膜炎可能提示LIU。