PDF(Pubmed)
Abstract：
BACKGROUND: The destruction of blood eye barrier and the administration of corticosteroid eyedrops after phacoemulsification surgery can lead to the replication of the local potential pathogens. With the rapid increase and popularization of cataract surgery, all kinds of rare postoperative complications have appeared. Here, we report a case of interstitial keratitis and secondary glaucoma after cataract surgery, which may be related to late congenital syphilis, which eventually led to blindness in the right eye. We hope that the timely report of this case will enable doctors to pay more attention to the possibility of potential pathogen replication after cataract surgery, and enable more patients to receive reasonable and effective treatment.
METHODS: A 63-year-old female was referred to our clinic for investigation with a 1-week history of moderate pain in the right eye and ipsilateral headache in January 2020. She had cataract surgery on her right eye two years ago and on her left eye one year ago. The intraocular pressure (IOP) in the right eye was 43.2 mmHg and that in the left eye was 28.5 mmHg. Her right eye underwent medication, trabeculectomy and finally was subjected to ciliary body photocoagulation to control the IOP. The IOP of the left eye was well controlled by regular use of eye drops. In addition to the elevated IOP, the inflammation of the anterior segment and corneal stroma was found. Before cataract surgery, bilateral corneal opacities was revealed, but after cataract surgery, interstitial keratitis in both eyes was gradually aggravated, during the follow-up period from 2019 to 2021. She informed us that she had suffered from decreased vision in both eyes and was diagnosed with bilateral keratitis and congenital syphilis at the age of 20. In 2018, the serologic test for syphilis was positive in blood (Chemiluminescence analysis (CLIA): + ; Toluidine red unheated serum test (TRUST): + , titer was 1:1). However, four tests for TRUST were negative in 2019 and 2020, so she was not treated for syphilis.
CONCLUSIONS: This case of glaucoma and interstitial keratitis might be secondary to ocular inflammation caused by late congenital syphilis. The ocular inflammation and the activation of syphilis may be related to cataract surgery.
METHODS: A 63-year-old female was referred to our clinic for investigation with a 1-week history of moderate pain in the right eye and ipsilateral headache in January 2020. She had cataract surgery on her right eye two years ago and on her left eye one year ago. The intraocular pressure (IOP) in the right eye was 43.2 mmHg and that in the left eye was 28.5 mmHg. Her right eye underwent medication, trabeculectomy and finally was subjected to ciliary body photocoagulation to control the IOP. The IOP of the left eye was well controlled by regular use of eye drops. In addition to the elevated IOP, the inflammation of the anterior segment and corneal stroma was found. Before cataract surgery, bilateral corneal opacities was revealed, but after cataract surgery, interstitial keratitis in both eyes was gradually aggravated, during the follow-up period from 2019 to 2021. She informed us that she had suffered from decreased vision in both eyes and was diagnosed with bilateral keratitis and congenital syphilis at the age of 20. In 2018, the serologic test for syphilis was positive in blood (Chemiluminescence analysis (CLIA): + ; Toluidine red unheated serum test (TRUST): + , titer was 1:1). However, four tests for TRUST were negative in 2019 and 2020, so she was not treated for syphilis.
CONCLUSIONS: This case of glaucoma and interstitial keratitis might be secondary to ocular inflammation caused by late congenital syphilis. The ocular inflammation and the activation of syphilis may be related to cataract surgery.
摘要：
背景：超声乳化手术后血眼屏障的破坏和皮质类固醇滴眼液的使用可导致局部潜在病原体的复制。随着白内障手术的迅速增加和普及,各种罕见的术后并发症出现。这里,我们报道一例间质性角膜炎和白内障手术后继发性青光眼，这可能与晚期先天性梅毒有关，最终导致右眼失明。我们希望这一病例的及时报告能让医生更加关注白内障术后潜在病原体复制的可能性,使更多的患者得到合理有效的治疗。
方法：2020年1月，一名63岁女性因右眼中度疼痛和同侧头痛1周病史被转诊到我们的诊所进行调查。两年前，她的右眼和一年前的左眼进行了白内障手术。右眼的眼内压（IOP）为43.2mmHg，左眼的眼内压为28.5mmHg。她的右眼接受了药物治疗，小梁切除术，最后进行睫状体光凝控制眼压。通过定期使用滴眼剂可以很好地控制左眼的IOP。除了IOP升高,发现了眼前段和角膜基质的炎症。白内障手术前，发现双侧角膜混浊,但白内障手术后,双眼间质性角膜炎逐渐加重，2019年至2021年的后续期间。她告诉我们，她患有双眼视力下降，并在20岁时被诊断出患有双侧角膜炎和先天性梅毒。2018年，血液中梅毒血清学检测呈阳性（化学发光分析（CLIA）：+；甲苯胺红未加热血清试验（TRUST）：+，滴度为1：1）。然而,2019年和2020年的4项TRUST检测均为阴性,因此她未接受梅毒治疗.
结论：此例青光眼和间质性角膜炎可能继发于晚期先天性梅毒引起的眼部炎症。眼部炎症和梅毒的激活可能与白内障手术有关。
方法：2020年1月，一名63岁女性因右眼中度疼痛和同侧头痛1周病史被转诊到我们的诊所进行调查。两年前，她的右眼和一年前的左眼进行了白内障手术。右眼的眼内压（IOP）为43.2mmHg，左眼的眼内压为28.5mmHg。她的右眼接受了药物治疗，小梁切除术，最后进行睫状体光凝控制眼压。通过定期使用滴眼剂可以很好地控制左眼的IOP。除了IOP升高,发现了眼前段和角膜基质的炎症。白内障手术前，发现双侧角膜混浊,但白内障手术后,双眼间质性角膜炎逐渐加重，2019年至2021年的后续期间。她告诉我们，她患有双眼视力下降，并在20岁时被诊断出患有双侧角膜炎和先天性梅毒。2018年，血液中梅毒血清学检测呈阳性（化学发光分析（CLIA）：+；甲苯胺红未加热血清试验（TRUST）：+，滴度为1：1）。然而,2019年和2020年的4项TRUST检测均为阴性,因此她未接受梅毒治疗.
结论：此例青光眼和间质性角膜炎可能继发于晚期先天性梅毒引起的眼部炎症。眼部炎症和梅毒的激活可能与白内障手术有关。
