巨穹窿症候群可能造成慢性结膜炎


  Aug. 5, 2004 - 一项发表于8月号眼科学期刊的回溯性试验结果指出,巨穹窿症候群可能是慢性结膜炎的原因之一。
  
  英国伦敦Moorfields眼科医院Geoffrey E. Rose指出,这项试验的目的要描述一群表现出慢性、复发性的、严重化脓结膜炎,这是一种常因一大群卡在大的上结膜穹窿位置蛋白凝块上的细菌,且这些细菌因被隔离的关系,而导致反覆感染的老年病患表现。
  
  这项回溯性试验回顾一群非对比病例,共有12位就诊于Moorfields眼科医院泪腺门诊、慢性复发细菌性结膜炎病史病患,其中10位是女性,年龄范围从77至93岁(平均85岁;中位数86岁);所有病患中除了2位外,其余都患有单侧结膜炎;转诊前结膜炎发病时间范围从8至48个月(平均23.5个月;中位数24个月),所有病患均因反覆明显化脓性结膜炎及慢性眼化脓而接受多次治疗疗程。
  
  3位病患在诊断出巨穹窿症候群前,因为鼻泪管阻塞而成功地接受外泪腺切除术;转诊前,9位病患已经发生角膜血管化以及结疤,且5位病患之前患有自发性角膜穿孔或是变薄;所有病患都有与提肌腱膜裂、大量浓且化脓的碎片、以及卡在上穹窿深处黄色硬块有关的上结膜穹窿;所有病患的碎片细菌培养结果,都发现呈金黄色葡萄球菌阳性。
  
  研究中,这些患者被施以适当的全身性抗生素(ciprofloxacin或olflxacin)、密集的局部抗生素、及高剂量、高效价类固醇治疗,以促进结膜炎消退;而为了预防再发,某些病患需要反覆治疗或是持续使用类固醇-抗生素合并眼药水。
  
  Mr. Rose指出,老年人大容量的上穹窿可能隐藏受到金黄色葡萄球菌植入的凝块而导致慢性结膜炎,可能因为毒性角膜病变与继发性角膜血管化,而导致严重视觉受损;任何患有反覆再发性化脓结膜炎及慢性毒性角膜炎,特别是当这些复发发生于成功的泪腺引流手术后的老年病患,都应该评估是否为巨穹窿症候群所致。

Giant Fornix Syndrome May Caus

By Laurie Barclay, MD
Medscape Medical News

Aug. 5, 2004 — Giant fornix syndrome may be a cause of chronic conjunctivitis, according to the results of a retrospective study published in the August issue of Ophthalmology.

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The aim of this study was "to describe a group of elderly patients presenting with chronic, relapsing, copiously purulent conjunctivitis, in which the condition was often perpetuated by the sequestration of a large number of bacteria on a protein coagulum lodged in the recesses of a large upper conjunctival fornix," writes Geoffrey E. Rose, from the Moorfields Eye Hospital in London, U.K.

In this retrospective review of a noncomparative case series, 12 patients, including 10 women, attending the lacrimal clinic at Moorfields Eye Hospital had a history of chronic relapsing bacterial conjunctivitis. Age range was 77 to 93 years (mean, 85; median, 86). In all but two patients, the conjunctivitis was unilateral. Duration of conjunctivitis before referral ranged from eight to 48 months (mean, 23.5; median, 24). All patients had received multiple courses of treatment for repeated episodes of markedly purulent conjunctivitis and chronic ocular discharge.

Three patients had successful external dacryocystorhinostomy for nasolacrimal duct occlusion before being diagnosed with giant fornix syndrome. Before referral, nine patients had developed corneal vascularization and scarring, and five had suffered prior spontaneous corneal perforation or thinning. All patients had deep upper conjunctival fornices associated with age-related dehiscence of the levator muscle aponeurosis, copious amounts of thick, purulent debris, and a yellow coagulum lodged in the depths of the upper fornix. Cultures of the debris were positive for Staphylococcus aureus in all patients.

Appropriate systemic antibiotics (ciprofloxacin or ofloxacin), intensive topical antibiotics, and high-dose, high-potency steroids led to prompt resolution of conjunctivitis. To prevent relapse, some patients required repeated treatment or continued use of a single drop of a combined steroid-antibiotic.

"The capacious upper fornix of the elderly may harbor a coagulum colonized by S. aureus, leading to chronic conjunctivitis that may lead to severe sight impairment due to toxic keratopathy and secondary corneal vascularization," Mr. Rose writes. "The giant fornix syndrome should be considered in any elderly patient in whom there is repeated relapse of a purulent conjunctivitis and a chronic toxic keratitis — especially when these relapses occur (enigmatically) after successful lacrimal drainage surgery."

The author reports no potential financial conflicts of interest.

Ophthalmology. 2004;111:1539-1545

Reviewed by Gary D. Vogin, MD

    
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