梅毒—一个尚未充分认识的引起年老患者术后葡萄膜炎的原因(英文)

Syphilis:an under-recognized cause of postoperative uveitis in elderly

目的:报告1例年长患者因梅毒继发的术后葡萄膜炎。方法:一例76岁的马来西亚男性患者,双眼为未成熟期白内障,右眼顺利进行了白内障超声乳化术,既往无葡萄膜炎病史。术后5d,右眼突然出现视物模糊,眼部检查发现角膜弥漫性水肿、中度前房反应和眼压升高。结果:局部应用抗生素和类固醇药物效果良好,眼压经用抗青光眼药得到控制。然而,术后3wk,右眼再次发生疼痛、红肿、视物模糊,眼部检查显示严重的前葡萄膜炎伴有羊脂状角膜后沉积物出现,VDRL和TPHA阳性证实为梅毒,通过全身注射青霉素类药物和局部应用类固醇药物,病情明显好转。结论:这个病例证明在年长患者梅毒是未被充分认识的引起术后葡萄膜炎的病因,应用青霉素可获得快速显著的治疗效果。

AIM：To report a case of postoperative uveitis secondary to syphilis in an elderly patient.METHODS：A 76-year-old Malay man,a case of bilateral immature cataract underwent uneventful right phacoemulsification.There was no history of uveitis before.On day 5 post operation,he developed sudden onset of vision blurring in the right eye.Examination showed generalized cornea edema with moderate anterior chamber reaction and increased intraocular pressure.RESULTS：The patient responded well to topical antibiotic and steroid.The intraocular pressure was controlled with anti-glaucoma agent.However,the patient developed similar episode of pain,redness and poor vision in the same eye after 3 weeks.Ocular examination revealed severe anterior uveitis with presence of mutton fat keratic precipitates.Venereal disease research laboratory（VDRL）and treponema pallidum hemagglutination assay（TPHA）were positive suggesting syphilis.The condition improved markedly with benzathine penicillin injection and topical steroid.CONCLUSION：This case illustrates syphilis as an under-recognized cause of postoperative uveitis in the elderly.Appropriate management with penicillin has showed rapid and remarkable outcome.