玻璃体手术后交感性眼炎的临床及病理学观察

Clinical and histopathological observations on sympathetic ophthalmia after vitrectomy

目的观察玻璃体手术后交感性眼炎的临床特点及病理学改变。方法回顾性分析1998年1月至2004年12月期间13000例玻璃体手术后8例交感性眼炎患者的临床资料，并对其中3例摘除的诱发眼进行了病理学观察。结果交感性眼炎的发生率为0.06%。发生交感性眼炎的时间距最后一次玻璃体手术的时间为7～150d，平均时间为（77.8±50.8）d。主要表现为交感眼视力下降、视物变形，眼红，眼痛。发病时交感眼视力为手动～0.5，诱发眼视力为无光感～0.04。双眼羊脂状角膜后沉着、前房闪辉及细胞、玻璃体混浊、视盘水肿充血、后极部视网膜水肿，2例交感眼有渗出性视网膜脱离。所有患者经口服泼尼松1.0～1.5mg/kg治疗后交感眼和诱发眼视力均有不同程度恢复。3例患者因诱发眼视力丧失行眼球摘除手术。被摘除的诱发眼病理检查表现为葡萄膜弥漫性淋巴细胞浸润增厚，类上皮细胞结节形成，淋巴细胞浸润巩膜孔道，眼球萎缩。结论玻璃体手术后交感性眼炎发生率为0.06%；大多数发生在手术后3个月内；其临床表现及病理学检查符合交感性眼炎的特征。

Objective To evaluate the clinical and histopathological manifestations of sympathetic ophthalmia after pars plana vitrectomy. Methods The clinical data of 8 patients with sympathetic ophthalmia out of 13 000 who underwent pars plana vitrectomy from Jan 1998 to Dec 2004 were retrospectively analyzed. In the 8 patients, 3 evoked eyes underwent ophthalmectomy and were observed histopathologically. Results The incidence of sympathetic ophthalmia was 0. 06%. The time from vitrectomy to the occurrence of sympathetic ophthalmia ranged from 7 to 150 days, with a median of （77.8 ± 50.8） days. All patients had decrease of visual acuity of the sympathetic eye, visual distortion, red eye, and opthalmalgia. The visual acuity was hand moving to 0. 5 in the sympathetic eyes, and no light perception to 0. 04 in the evoked eyes. Other clinical manifestations included binocular mutton-fat keratic precipitates, anterior chamber flare and cells, vitreous opacity, optic-disc edema and hyperaemia, and retinal edema at the posterior pole; 2 sympathetic eyes had exudative retinal detachment. The visual acuity increased to 0. 4-1.2 in sympathetic eyes and light perception -0. 25 in evoked eyes in all of the patients after treatment with oral administration of prednisone 1. 0-1. 5 mg/kg. In the 3 patients who had undergone ophthalmectomy because of total loss of visual acuity, and the pathological examination revealed infiltrated and thicked uvea due to lymphocytes, epithelioid cell nodules, infiltration of lymphocytes to sclerotic passages, and ocular atrophy were observed. Conclusion The incidence of sympathetic ophthalmia is 0.06%, which happened within 3 months after vitrectomy. The clinical manifestations and results of histological examinations accords with the characteristics of sympathetic ophthalmia.