目的:描述一例预防性使用非甾体抗炎药(NSAID)滴眼液导致角膜反复融化并伴有视力丧失的病例,并进行简要文献综述。
方法:这是一例84岁糖尿病女性慢性干眼的病例报告,由两位不同的外科医生以不同的时间间隔对每只眼睛进行手术。她仅在第二次手术后接受了局部NSAID预防,由于复发性角膜融化和慢性脉络膜积液导致失明。我们还提供了一个简短的文献综述。
结果:这位女士在第二只眼常规白内障手术后使用局部NSAIDs预防5天后出现角膜融化和穿孔。不幸的是,尽管角膜胶粘,但所有挽救视力和眼睛的努力都没有成功,因为她反复出现并发症,羊膜,穿透性角膜移植术,和tarsorrhy。她还患有慢性脉络膜积液。她最终得到了一个不透明的角膜和一个小全眼镜检查,由于全身健康状况不佳,她没有资格进行镇静或全身麻醉,因此没有其他改善视力的选择。
结论:虽然糖尿病患者通常使用NSAIDs与类固醇滴眼液联合使用以降低白内障手术后黄斑囊样水肿的风险,合并干眼的老年糖尿病患者应被视为角膜融化的高风险,应密切监测。该病例突出了在脆弱的角膜中局部预防NSAIDs的罕见但严重的并发症,这需要仔细考虑。
OBJECTIVE: To describe a case where prophylactic use of nonsteroidal anti-inflammatory drugs (NSAID) eye drops lead to recurrent corneal melt with loss of vision and a brief literature review.
METHODS: This is a case report of an 84-year-old diabetic female with chronic dry eye, operated by two different surgeons on each eye at different time intervals. She received topical NSAID prophylaxis after the second surgery only, which led to blindness due to recurrent corneal melt and chronic choroidal effusions. We also present a brief literature review.
RESULTS: This lady presented with corneal melt and perforation 5 days following the use of topical NSAIDs prophylaxis after a routine cataract surgery in the second eye. Unfortunately, all efforts to save her vision and eye were unsuccessful as she developed repeated complications in spite of corneal gluing, amniotic membrane, penetrating keratoplasty, and tarsorrhaphy. She also had chronic choroidal effusions. She ended up with an opaque cornea and a subtotal tarsorrhaphy, with no other option to improve her vision as she did not qualify for sedation or general anesthesia due to her poor systemic health.
CONCLUSIONS: Although it is a common practice for diabetic patients to have topical NSAIDs prophylaxis in combination with steroid eye drops to reduce the risk of cystoid macular edema after cataract surgery, the elderly diabetic patients with concomitant dry eyes should be considered high risk for corneal melt and should be closely monitored. This case highlights the rare but serious complication of topical NSAIDs prophylaxis in the vulnerable cornea, which warrants careful consideration.