Salt Lake City, Utah.
J Cataract Refract Surg. 2023 Apr 1;49(4):443. doi: 10.1097/j.jcrs.0000000000001181.
A 24-year-old woman presented with a 7-day history of blurry vision, redness, and extreme pain in her right eye. She had no pertinent medical or ocular history and did not use spectacles or contacts. Uncorrected distance visual acuity (UDVA) was 20/40 in the right eye and could not be improved with refraction. Slitlamp examination revealed a 1.5 × 1.5 mm central epithelial defect with surrounding white blood cell recruitment. Confocal microscopy (Figure 1JOURNAL/jcrs/04.03/02158034-202304000-00020/figure1/v/2023-03-24T200747Z/r/image-tiff) was performed, and she was treated with chlorhexidine 0.02% drops every hour in the right eye. 2 weeks later, the cornea had completely re-epithelialized; however, persistent corneal haze, decreased visual acuity, and corneal thinning and flattening was noted. Pachymetry was 484 µm in the right eye and UDVA was 20/40 (Supplemental Figure 1, available at http://links.lww.com/JRS/A836). In the following 2 weeks, UDVA improved to 20/25. 6 months after the initial presentation, UDVA was unchanged and faint central corneal haze was noted on examination (Figure 2JOURNAL/jcrs/04.03/02158034-202304000-00020/figure2/v/2023-03-24T200747Z/r/image-tiff). Of interest, her family history is significant for her younger 16-year-old brother with 3 prior episodes of a similar type of keratitis/keratopathy over the course of 2 years in both eyes with similar central paracentral corneal haze, thinning, and flattening and similar confocal findings (Figure 3JOURNAL/jcrs/04.03/02158034-202304000-00020/figure3/v/2023-03-24T200747Z/r/image-tiff). He also was unresponsive to topical antibiotics and antivirals except topical chlorhexidine. Her brother has been our patient for the last several years prior to her first visit to our clinic. What is your diagnosis? What medical diagnostic tests, if any, would you recommend? Is this an infectious or simply an inflammatory response? Is there any genetic or familial predisposition?
一位 24 岁女性因右眼视力模糊、发红和极度疼痛就诊，病史 7 天。她无相关医学或眼部病史，不戴眼镜或隐形眼镜。右眼未经矫正的远视力（UDVA）为 20/40，无法通过矫正提高。裂隙灯检查显示中央 1.5×1.5mm 上皮缺损，周围有白细胞募集。共焦显微镜检查（图 1）进行，并在右眼每小时滴用氯己定 0.02%。2 周后，角膜完全再上皮化；然而，仍存在持续性角膜混浊、视力下降以及角膜变薄和变平。右眼角膜厚度为 484μm，UDVA 为 20/40（补充图 1，可在 http://links.lww.com/JRS/A836 获得）。在接下来的 2 周内，UDVA 提高至 20/25。初次就诊后 6 个月，UDVA 保持不变，检查时发现中央角膜隐约混浊（图 2）。有趣的是，她的家族史中，她 16 岁的弟弟在 2 年内双眼出现 3 次类似类型的角膜炎/角膜病，同样存在中央旁中央角膜混浊、变薄和变平以及类似的共焦镜检查结果（图 3）。他也对局部抗生素和抗病毒药物反应不佳，仅对局部氯己定敏感。在她第一次到我们诊所就诊之前的几年里，她的弟弟一直是我们的患者。你的诊断是什么？你会推荐哪些医学诊断测试？这是感染性的还是单纯的炎症反应？是否存在遗传或家族易感性？
