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中华眼科医学杂志(电子版) ›› 2025, Vol. 15 ›› Issue (02) : 109 -113. doi: 10.3877/cma.j.issn.2095-2007.2025.02.008

病例报告

巩膜镜治疗Stevens-Johnson综合征1例
丁美华1, 李国平1, 原越2, 张诚诚1, 孙伟1, 温莹2, 毕宏生3,   
  1. 1. 250002 济南,山东中医药大学附属眼科医院视光科
    2. 250002 济南,山东中医药大学附属眼科医院角膜病科
    3. 250002 济南,山东中医药大学附属眼科医院 山东省眼病防治研究院 山东中医药大学
  • 收稿日期:2025-02-06 出版日期:2025-04-28
  • 通信作者: 毕宏生
  • 基金资助:
    山东省医务职工科技创新计划项目(SDYWZGKCJH2024012)

Scleral mirror treatment for Stevens Johnson syndrome: a case report

Meihua Ding, Guoping Li, Yue Yuan, Chengcheng Zhang, Wei Sun, Ying Wen, Hongsheng Bi   

  • Received:2025-02-06 Published:2025-04-28
  • Corresponding author: Hongsheng Bi
引用本文:

丁美华, 李国平, 原越, 张诚诚, 孙伟, 温莹, 毕宏生. 巩膜镜治疗Stevens-Johnson综合征1例[J/OL]. 中华眼科医学杂志(电子版), 2025, 15(02): 109-113.

Meihua Ding, Guoping Li, Yue Yuan, Chengcheng Zhang, Wei Sun, Ying Wen, Hongsheng Bi. Scleral mirror treatment for Stevens Johnson syndrome: a case report[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2025, 15(02): 109-113.

图1 裂隙灯显微镜患者双眼角膜彩色照像及角膜荧光素染色后采用钴蓝光检查照像 图1A和图1B示上、下方角膜上皮缺失糜烂,部分融合;图1C和图1D示角膜荧光素染色后在钴蓝光下观察图像 图2 患者双眼睑板腺裂隙灯显微镜彩色照像 图2A和图2B示双眼上下睑板腺开口部分阻塞,可见脂栓(2分);图1C和图1D示双眼上、下睑板腺大面积缺失萎缩(3分)
图3 患者验配巩膜镜前裂隙灯显微镜检查睑板腺开口彩色照像及角膜荧光素染色后采用钴蓝光检查照像图3A和图3B示双眼睑板腺开口部分阻塞,可见脂栓,球结膜充血;图3C示和图3D示角膜上皮Ⅱ级点染,中央及中周部角膜可见浅基质云翳,大小不等,约0.5 mm×0.5 mm至2 mm×2 mm;图3E及图3F示角膜荧光素染色后在钴蓝光下观察图像 图4 患者配戴巩膜镜前采用前节光学相干断层扫描进行双眼矢高测量和戴镜沉降2 h后间隙测量图像 图4A和图4B示配戴巩膜镜前弦长(初始试戴片直径-1.5 mm=14.1 mm)对应的矢高;图4C和图4D示戴镜沉降2 h后角膜中央间隙、鼻侧或颞侧角巩膜缘间隙及着陆区;图4E及图4F示戴镜沉降2 h后上方或下方角巩膜缘间隙及着陆区
表1 患者入院时眼前节情况及治疗方案
体征与治疗 第1次住院(6d) 第2次住院(9d) 第3次住院(16d)
眼前节情况 双眼角膜上皮弥漫粗糙,上下方大范围缺失糜烂,融合成片 双眼角膜上皮复发缺失糜烂,右眼上方6mm×4mm,左眼下方7mm×3mm 左眼角膜上皮复发缺失糜烂5mm×4.5mm
药物治疗 50%自体血清,1次/2h[1];1%玻璃酸钠滴眼液(必要时);重组牛碱性成纤维细胞生长因子凝胶(21000IU/5g,4次/d);0.05%环孢素滴眼液,3次/d;0.1%氟米龙滴眼液,4次/d;妥布霉素地塞米松眼膏3.5g(10.5mg妥布霉素+3.5mg地塞米松),2次/d;氧氟沙星眼膏(3.5g:10.5mg),2次/d 50%自体血清,1次/2h[1];1%玻璃酸钠滴眼液(必要时);20%小牛血去蛋白提取物眼用凝胶5g,4次/d;0.05%环孢素滴眼液,3次/d;0.5%氯替泼诺混悬滴眼液,4次/d;左氧氟沙星滴眼液(5ml:24.4mg),4次/d 50%自体血清,1次/2h[1];1%玻璃酸钠滴眼液(必要时);20%小牛血去蛋白提取物眼用凝胶5g,4次/d;0.05%环孢素滴眼液,3次/d;0.5%氯替泼诺混悬滴眼液,4次/d;左氧氟沙星滴眼液(5ml:24.4mg),4次/d
手术治疗 双眼泪小点栓塞术(0.5mm直径,可降解泪小管塞栓);双眼羊膜移植术
物理治疗 睑板腺按摩清洁(1次/2周);强脉冲光(Lumenis M22,1次/2周)[2] 睑板腺按摩清洁(1次/2周);强脉冲光(Lumenis M22,1次/2周)[2] 睑板腺按摩清洁(1次/2周);强脉冲光(Lumenis M22,1次/2周)[2]
表2 配戴巩膜镜前后眼部症状及体征
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