Abstract：
BACKGROUND: High-dose systemic cytarabine chemotherapy may cause fine corneal opacities and refractile microcysts, which are densely distributed in the center of the cornea. Most previous case reports on microcysts have been those following complaints of subjective symptoms, and the findings at the initial stage of development and time-course changes are still unknown. This report aims to clarify the time-course changes of microcysts using slit-lamp photomicrographs.
METHODS: A 35-year-old woman who was treated with high-dose systemic cytarabine therapy (3 courses of 2 g/m2 every 12 h for 5 days) for acute myeloid leukemia and presented with subjective symptoms, such as bilateral conjunctival injection, photophobia, and blurred vision, on the 7th day of treatment in both the first two courses. Anterior segment findings by slit-lamp microscopy revealed microcysts densely distributed in the central region of the corneal epithelium. In both courses, microcysts disappeared within 2-3 weeks upon prophylactic steroid instillation. In the 3rd course, daily ophthalmic examinations were conducted from the start of the treatment, and on the 5th day without subjective symptoms, the microcysts in the corneal epithelium appeared evenly and sparsely distributed throughout the cornea except for the corneal limbus. Thereafter, the microcysts accumulated towards the center of the cornea and disappeared gradually. The change from low-dose to full-strength steroid instillation immediately following the occurrence of microcysts in the 3rd course resulted in the peak finding being the mildest compared to that in the past two courses.
CONCLUSIONS: Our case report revealed that microcysts appeared scattered throughout the cornea before the appearance of subjective symptoms and then accumulated in the center and disappeared. A detailed examination is necessary to detect early changes in microcyst development resulting in prompt and appropriate treatment.
METHODS: A 35-year-old woman who was treated with high-dose systemic cytarabine therapy (3 courses of 2 g/m2 every 12 h for 5 days) for acute myeloid leukemia and presented with subjective symptoms, such as bilateral conjunctival injection, photophobia, and blurred vision, on the 7th day of treatment in both the first two courses. Anterior segment findings by slit-lamp microscopy revealed microcysts densely distributed in the central region of the corneal epithelium. In both courses, microcysts disappeared within 2-3 weeks upon prophylactic steroid instillation. In the 3rd course, daily ophthalmic examinations were conducted from the start of the treatment, and on the 5th day without subjective symptoms, the microcysts in the corneal epithelium appeared evenly and sparsely distributed throughout the cornea except for the corneal limbus. Thereafter, the microcysts accumulated towards the center of the cornea and disappeared gradually. The change from low-dose to full-strength steroid instillation immediately following the occurrence of microcysts in the 3rd course resulted in the peak finding being the mildest compared to that in the past two courses.
CONCLUSIONS: Our case report revealed that microcysts appeared scattered throughout the cornea before the appearance of subjective symptoms and then accumulated in the center and disappeared. A detailed examination is necessary to detect early changes in microcyst development resulting in prompt and appropriate treatment.
摘要：
背景：大剂量的全身阿糖胞苷化疗可能会导致角膜病变和折射性小囊肿，密集分布在角膜中心。以前大多数关于微囊肿的病例报告都是在主诉后出现的，发展初期的发现和时程变化仍然未知。本报告旨在使用裂隙灯显微照片阐明微囊的时程变化。
方法：一名35岁女性，因急性髓系白血病接受大剂量系统性阿糖胞苷治疗（每12小时3个疗程2g/m2，共5天），出现主观症状，如双侧结膜注射，畏光,视力模糊,在前两个疗程的治疗第7天。通过裂隙灯显微镜检查发现的前段发现，微囊肿密集分布在角膜上皮的中央区域。在这两个课程中，预防性类固醇滴注后，微小囊肿在2-3周内消失。在第3道菜中，从治疗开始每天进行眼科检查，在没有主观症状的第5天，除角膜缘外，角膜上皮中的小囊肿均匀且稀疏分布在整个角膜中。此后,微囊肿向角膜中心积聚并逐渐消失。在第3个疗程的微囊肿发生后，立即从低剂量滴注到全强度类固醇滴注的变化导致与过去两个疗程相比，峰值发现是最温和的。
结论：我们的病例报告显示，在出现主观症状之前，微囊肿出现在整个角膜上，然后在中心积聚并消失。需要进行详细的检查以检测微囊肿发育的早期变化，从而进行及时和适当的治疗。
方法：一名35岁女性，因急性髓系白血病接受大剂量系统性阿糖胞苷治疗（每12小时3个疗程2g/m2，共5天），出现主观症状，如双侧结膜注射，畏光,视力模糊,在前两个疗程的治疗第7天。通过裂隙灯显微镜检查发现的前段发现，微囊肿密集分布在角膜上皮的中央区域。在这两个课程中，预防性类固醇滴注后，微小囊肿在2-3周内消失。在第3道菜中，从治疗开始每天进行眼科检查，在没有主观症状的第5天，除角膜缘外，角膜上皮中的小囊肿均匀且稀疏分布在整个角膜中。此后,微囊肿向角膜中心积聚并逐渐消失。在第3个疗程的微囊肿发生后，立即从低剂量滴注到全强度类固醇滴注的变化导致与过去两个疗程相比，峰值发现是最温和的。
结论：我们的病例报告显示，在出现主观症状之前，微囊肿出现在整个角膜上，然后在中心积聚并消失。需要进行详细的检查以检测微囊肿发育的早期变化，从而进行及时和适当的治疗。
