后房型人工晶体植入术后迟发性葡萄膜炎

Delayed acute uveitis after cataract extraction with the implantation of PC-IOL

目的 :探讨白内障摘除后房型人工晶体植入术后迟发性葡萄膜炎的发病机制。方法 :对白内障超声乳化吸除后房型人工晶体植入术后 12例 13眼迟发性葡萄膜炎患者资料进行回顾性总结分析。本组老年性白内障患者 ,男 4例 5眼 ,女 8例 8眼 ,平均年龄 6 2岁 (43～ 72岁 )。常规完成白内障超声乳化吸除后房型人工晶体植入。在术后早期 (7～ 10天 )眼内炎症完全消失或基本消失的情况下 ,突然发生急性葡萄膜炎症反应 ,发病时间最早在术后第 12天 ,最迟 34天 ,平均 17.93天。结果 :经局部及全身皮质类固醇、消炎痛治疗 ,6～ 15天眼部炎症完全消失 ,视力恢复良好 ,无严重并发症与后遗症。随访 6～ 2 4个月 ,平均 18.6个月 ,无一例复发 ,视力稳定。结论 :后房型人工晶体植入术后迟发性葡萄膜炎是由免疫复合物介导的急性葡萄膜炎症反应 ,及时正确处理 ,可获得较好的效果。随着手术后时间的推移 ,免疫复合物逐渐清除及人工晶体在眼内耐受 。

Objective: To investigate the mechanism of delayed acute uveitis after cataract extraction with the implantation of posterior chamber intraocular lens (PC-IOL). Methods: 13 eyes of 12 patients with delayed acute uveitis after phacoemulsification with PC-IOL were summarized. Patients (4 males, 8 females) were with senile cataract, aging from 43 to 72 (average 62). The acute uveitis suddenly occurred after early inflammatory reaction disappeared within postoperative 7 to 10 days. The time period during which the acute uveitis occurred was 1234 days (average 17.93 days) after the operation. Results: All patients were treated in corticosteroid and indomethacinum locally and generally, the inflammatory reaction of the eye disappeared (6-15days), the visual acuity recovered well, without any serious complications and after-effects. Followed up for 6 to 24months (average 18.6 months), the acute uveitis did not occur again, the visual acuity kept well. Conclusions: The immune complex is considered as the factor of delayed acute uveitis after cataract extraction with PC-IOL. The prognosis depends on the early active treatment. As the time after the operation goes by, the immune complex is being cleaned gradually and the intraocular lens are being more and more adaptable, the incidence of delayed acute uveitis is found to be decreased.