Taguchi Koichi, Toshida Hiroshi, Kimura Saya, Suto Chikako
Ophthalmology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, JPN.
Ophthalmology, Juntendo University Shizuoka Hospital, Shizuoka, JPN.
Cureus. 2024 Nov 27;16(11):e74579. doi: 10.7759/cureus.74579. eCollection 2024 Nov.
We report a case of sympathetic ophthalmia that developed in the fellow eye following therapeutic corneal transplantation and amniotic membrane transplantation for corneal perforation caused by corneal ulceration. A 62-year-old man presented with discharge, lacrimation, and decreased visual acuity in the left eye. He was diagnosed with a corneal ulcer and treated with antimicrobial agents, but corneal epithelial erosion persisted, leading to nontraumatic corneal perforation. The patient underwent therapeutic lamellar keratoplasty and amniotic membrane transplantation, but corneal epithelial erosion remained. Subsequently, conjunctival flap surgery and tarsorrhaphy were performed. Soon after, sympathetic ophthalmia developed in the fellow eye, and pulse steroid therapy was initiated. Although recurrence occurred during steroid tapering, a second pulse steroid therapy with a gradual dosage reduction over about one year successfully prevented further recurrence. The patient completed steroid therapy with a good visual prognosis. This case highlights the development of sympathetic ophthalmia in the fellow eye after multiple surgeries for nontraumatic corneal perforation, and immediate steroid therapy proved effective.
我们报告了一例交感性眼炎病例，该病例发生在因角膜溃疡导致角膜穿孔而接受治疗性角膜移植和羊膜移植后，健眼中出现了交感性眼炎。一名62岁男性因左眼有分泌物、流泪及视力下降前来就诊。他被诊断为角膜溃疡，并接受了抗菌药物治疗，但角膜上皮糜烂持续存在，导致非创伤性角膜穿孔。患者接受了治疗性板层角膜移植和羊膜移植，但角膜上皮糜烂仍未愈合。随后进行了结膜瓣手术和睑裂缝合术。不久后，健眼发生了交感性眼炎，并开始了脉冲式类固醇治疗。尽管在类固醇减量过程中出现了复发，但第二次脉冲式类固醇治疗并在约一年时间内逐渐减少剂量，成功预防了进一步复发。患者完成了类固醇治疗，视力预后良好。该病例突出了非创伤性角膜穿孔多次手术后健眼发生交感性眼炎的情况，并且立即进行类固醇治疗被证明是有效的。
