Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, Sussex, UK.
Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, Sussex, UK
BMJ Case Rep. 2022 Apr 13;15(4):e246334. doi: 10.1136/bcr-2021-246334.
An 89-year-old man with multiple episodes of inferior corneal oedema and low-grade anterior segment inflammation over 18 months was diagnosed and managed as viral keratitis; however, the episodes kept recurring every time treatment, vis-à-vis topical steroids, were tapered or stopped. History of cataract surgery few months prior to onset of the symptoms, lack of other features of viral keratitis, such as keratic precipitates and inferior corneal oedema in the presence of slight pupillary peaking led to the suspicion of either a retained lens fragment (RLF) or other possible iatrogenic insult. This was confirmed by anterior segment optical coherence tomogram, which revealed the RLF in inferior angle; this was removed surgically as an emergency procedure. This resulted in significant improvement in the corneal oedema, as well as marked symptomatic relief confirmed by the patient.
一位 89 岁男性,在 18 个月内多次出现下角膜水肿和轻度前段炎症,被诊断为病毒性角膜炎,并接受了治疗;然而,每当治疗(即局部类固醇药物)逐渐减少或停止时,这些发作就会再次发生。在症状出现前几个月有白内障手术史,缺乏病毒性角膜炎的其他特征,如在轻微瞳孔膨隆时出现角膜后沉着物和下角膜水肿,这导致怀疑存在残留晶状体碎片(RLF)或其他可能的医源性损伤。这通过前段光学相干断层扫描得到证实,该检查显示在下角存在 RLF;随后紧急进行了手术切除。这导致角膜水肿显著改善,患者的症状也得到了明显缓解。