Wilhelmus K R, Keener M J, Jones D B, Font R L
Department of Ophthalmology, Baylor College of Medicine, Houston, TX.
Am J Ophthalmol. 1995 Jan;119(1):14-9. doi: 10.1016/s0002-9394(14)73808-5.
Certain drugs bind to anionic phospholipids of lysosomal membranes and produce progressive intracellular accumulation of lamellar inclusions. We studied two patients treated for opportunistic infections associated with the acquired immunodeficiency syndrome (AIDS), who developed bilateral ocular surface changes suggestive of drug-induced corneal lipidosis.
Two patients with AIDS had translucent vacuoles within the corneal epithelium and mild conjunctival hyperemia. Because the differential diagnosis included microsporidial keratoconjunctivitis, biopsies of the ocular surface were performed for histopathologic analysis.
Transmission electron microscopy of corneal epithelial debridement and conjunctival biopsy specimens showed intracellular, electron-dense lipoidal bodies and multilaminated lysosomal inclusions suggestive of a drug-induced lipidosis. Both patients also had tubuloreticular inclusions in conjunctival capillary endothelial cells. The ocular surface changes resolved within one to three months after dosage reduction or discontinuation of systemic ganciclovir and acyclovir.
Drug-induced phospholipidosis is a cause of punctate corneal epitheliopathy during AIDS, but the responsible agent remains to be identified.
某些药物与溶酶体膜的阴离子磷脂结合，导致板层状包涵体在细胞内逐渐蓄积。我们研究了两名因获得性免疫缺陷综合征（AIDS）并发机会性感染而接受治疗的患者，他们出现了提示药物性角膜脂质沉着症的双侧眼表改变。
两名艾滋病患者角膜上皮内有半透明空泡，结膜轻度充血。由于鉴别诊断包括微孢子虫性角膜结膜炎，因此对眼表进行活检以进行组织病理学分析。
角膜上皮清创和结膜活检标本的透射电子显微镜检查显示细胞内有电子致密的脂质体和多层溶酶体包涵体，提示药物性脂质沉着症。两名患者结膜毛细血管内皮细胞中也有管网状包涵体。在减少全身更昔洛韦和阿昔洛韦剂量或停药后1至3个月内，眼表改变消失。
药物性磷脂沉着症是艾滋病期间点状角膜上皮病变的一个原因，但致病药物仍有待确定。
