角膜移植术后眼部移植后淋巴细胞增生性疾病
Ocular post-transplant lymphoproliferative disorder after keratoplasty.
作者信息
Liu Linna, Chen Xiangxi, Wu Jianhua, Wang Guohua, Yan Jing, Zhang Rui
机构信息
Aier Eye Hospital of Wuhan University, Wuhan, China.
出版信息
Am J Ophthalmol Case Rep. 2025 Jul 23;39:102397. doi: 10.1016/j.ajoc.2025.102397. eCollection 2025 Sep.
PURPOSE
Epstein-Barr virus associated post-transplantation lymphoproliferative disorders (PTLD) is a common condition after solid-organ or allogeneic hematopoietic stem-cell transplants. But ocular involvement after keratoplasty remains a rare finding, and can be easily misdiagnosed.
OBSERVATIONS
We report a case of a 59-year-old man who presented with masquerade uveitis of right eye 4 months post penetrating keratoplasty and was ultimately diagnosed with ocular PTLD. The diagnosis relied on the presence of Epstein-Barr virus DNA in aqueous sample and iris specimens showed the presence of a B cell clone. The ocular condition was in complete remission after 15 intravitreal injections of methotrexate.
CONCLUSIONS AND IMPORTANCE
Local immunosuppression after keratoplasty can lead to ocular PTLD. Detection of Epstein-Barr virus DNA in intraocular fluid and tissue or cytological biopsy could help confirm the diagnosis.
目的
爱泼斯坦-巴尔病毒相关的移植后淋巴组织增生性疾病（PTLD）是实体器官或异基因造血干细胞移植后的常见病症。但角膜移植术后眼部受累仍然是罕见发现，且容易误诊。
观察结果
我们报告一例59岁男性，在穿透性角膜移植术后4个月出现右眼伪装性葡萄膜炎，最终被诊断为眼部PTLD。诊断依据是房水样本中存在爱泼斯坦-巴尔病毒DNA，虹膜标本显示存在B细胞克隆。经15次玻璃体内注射甲氨蝶呤后，眼部病情完全缓解。
结论与意义
角膜移植术后的局部免疫抑制可导致眼部PTLD。检测眼内液和组织中的爱泼斯坦-巴尔病毒DNA或进行细胞学活检有助于确诊。
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