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慢性Stevens-Johnson综合征的白内障手术:眼表面状况和预后

Narang P, Mohamed A, Mittal V, et al.

期刊名称:British Journal of Ophthalmology

卷期:2016年第100卷第11期

摘要

目的:旨在评估Stevens-Johnson综合征(SJS)慢性后遗症患者的白内障手术预后。方法及设置:南印度一家三级眼保健中心。设计:回顾性,非比较,连续,介入病例系列研究。研究期:20033月至20145月。1662名连续SJS患者中,包括32例进行白内障手术的患有SJS慢性后遗症(40只眼)的患者。主要预后指标有最佳矫正视力(BCVA)和眼表面稳定性。视力参考logMAR。结果:研究包括12例男性(37.5%)和20例女性(62.5%)。 8例(25%)进行双侧白内障手术。术前BCVA中值是1.61IQR0.80-2.78)(3只眼仅有光感)。术后立即中位BCVA0.60IQR0.30-1.48),与术前BCVA有显着差异(p <0.0001)。中位BCVA0.30IQR0.00-0.80),表明进一步改善。术后实现上述指标的中位时间为1.5个月(IQR8-3个月)。最后一次随访期的中位BCVA0.48IQR0.181.00)。白内障手术的优选类型是白内障超声乳化吸除。35只眼眼睛表面状况保持稳定(87.5%)。4只眼眼表面破坏(10%)。结论:术前和术后充分保持眼表面完整的SJS慢性后遗症患者的白内障手术预后较佳。

Aim To assess the outcome of cataract surgery in patients with chronic sequelae of StevensJohnson syndrome (SJS).Methods Setting: Tertiary eye care centre in South India. Design: Retrospective, non-comparative, consecutive, interventional case series. Study period: March 2003 to May 2014. Of the 1662 consecutive patients with SJS, 32 patients (40 eyes) with chronic sequelae of SJS who underwent cataract surgery were included. The main outcome measures were best-corrected visual acuity (BCVA) and ocular surface stabilisation. The visual acuity was expressed with reference to the logMAR.Results The study included 12 men (37.5%) and 20 women (62.5%). 8 patients (25%) had bilateral cataract surgeries. The median preoperative BCVA was 1.61 (IQR, 0.80 to 2.78) (only perception of light in three eyes). The median BCVA in the immediate postoperative period was 0.60 (IQR, 0.30 to 1.48) (perception of light in an eye) which was significantly different from the preoperative BCVA (p<0.0001). The median BCVA achieved was 0.30 (IQR, 0.00 to 0.80), suggesting further improvement. Median time taken to achieve this postoperatively was 1.5months (IQR, 8days to 3months). The median BCVA during the last follow-up was 0.48 (IQR, 0.18 to 1.00). The preferred type of cataract surgery was phacoemulsification. Ocular surface condition remained stable in 35 eyes (87.5%). Ocular surface breakdown in four eyes (10%) was managed appropriately.Conclusion Cataract surgery outcome can be visually rewarding in chronic sequelae of SJS provided ocular surface integrity is adequately maintained preoperatively and postoperatively.


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