双侧角膜穿孔

?本病例摘自年2月13日《新英格兰医学杂志》：

A61-year-oldwomanwithlong-standingrheumatoidarthritispresentedwiththesensationthatshehadaforeignbodyinherrighteye;shereportednosymptomsinherlefteye.Thepatienthadsystemicsymptomsassociatedwithherrheumatoidarthritis,withnosynovitis,andwasreceivingtreatmentwithnaproxen.Evaluationrevealedcornealperforationsinbotheyes,withirisprolapse,resultinginirregularpupils.Shealsohadcataracts,probablylong-standing,sinceshewasunperturbedbyhervisualacuity—20/intherighteyeand20/inthelefteye(PanelsAandB,respectively).Notably,theconjunctivaswereuninjected.Theerythrocytesedimentationratewasmmperhour.Oralsteroidswerestartedbeforetheinitiationofmethotrexate,andcorneal-patchgraftingwasperformed.Theanatomicalintegrityofbotheyeswaspreserved,albeitwithpersistentdefectsintheiris(PanelC,righteyeaftersurgicalrepair;PanelD,lefteyeaftersurgicalrepair),butacuitywaslimitedto20/intherighteyeand20/inthelefteyeowingtoprogressivecataracts.Cataractsurgerywasdeferreduntiltheseissueswereresolved.Cornealperforationsareasurgicalemergency.Progressionmaybepreventedbytheadministrationofimmunosuppressivetreatmentdirectedattheunderlyingrheumatoidarthritis.

61岁类风湿性关节炎长期病患者，因自觉右眼异物感求诊。自述左眼无任何症状。患者全身已出现类风湿性关节炎相关的所有症状，无关节滑膜炎，正接受萘普生治疗。检查发现双眼角膜穿孔伴虹膜脱出，导致瞳孔不等大。患者同时患有白内障，并可能已存在较长时间，因其视力长期稳定在以下水平：右眼20/，左眼20/（图A和图B）。值得注意的是结膜并未充血。红细胞沉降率为mm每小时。启动甲氨蝶呤治疗前先给予口服类固醇，并进行角膜植片修补术。尽管虹膜在手术后出现缺失，但双眼的解剖学完整性得到保留（图C和图D分别为右眼、左眼手术后的照片）。由于白内障病情出现进展，双眼视力始终维持在20/（右眼）和20/（左眼）。白内障手术需等到所有问题被解决后进行。角膜穿孔属急症手术。用于治疗潜在类风湿性关节炎的免疫抑制治疗可能有助预防病情进展。

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北京白癜风医院地址
白癜风早期有哪些症状