超声乳化白内障吸除术后单纯疱疹病毒性角膜炎的诊疗观察

Observation on diagnosis and treatment of herpes simplex keratitis after phacoemulsification surgery

目的回顾分析超声乳化白内障吸除＋人工晶体植入术后患单纯疱疹性角膜炎（HSK）患者的病例资料,对其诊疗进行总结归纳并分析探讨。方法 2009年4月至2010年4月眼科门诊随访超声乳化白内障吸除＋人工晶体植入术的患者,术后发生HSK 4眼。诊断明确给予抗病毒药物及角膜修复药物治疗。结果 4只眼均为单眼发病,其中2眼合并2型糖尿病。1眼表现为角膜上皮点状缺损,3眼表现为树枝状角膜浸润,荧光素染色均为（＋）。经抗病毒治疗7~21 d角膜修复,荧光染色（-）。随访3~6个月未见复发。结论尽管白内障术后HSK发生少见,但对合并糖尿病等全身抵抗力下降的患者,医师仍须警惕术后诱发HSK的可能。发现病毒感染后及时给予抗病毒治疗至关重要。

Objective To review and analyze the data of patients suffered from herpes simplex keratitis after phacoemulsification combined with intraocular lens implantation.Methods The clinical data of 4 eyes suffered from herpes simplex keratitis after surgery during April 2009 to April 2010 were retrospectively reviewed and analyzed.After the confirmation of diagnosis,all patients were administrated with antiviral and corneal restoration therapy.Results The keratitis in these 4 eyes was monocular.Keratitis of two eyes occurred in patients with diabetes mellitus.One eye manifested as punctate epithelial keratitis and three eyes as dendritis keratitis,and all of them were positive in corneal fluorescein staining（＋）.After antiviral therapy and corneal restoration for 7～21 days,their corneal lesions were healed,and their corneal fluorescein staining inverted to negative（-）.There was no patient recurred after followed up for 3~6 months.Conclusion Though the incidence of herpes simplex keratitis after cataract operation is uncommon,but ophthalmologists should keep vigilance to it especially in patients with diabetes or decreased systemic resistance.It is very important to give antiviral therapy in time for its treatment.