Blau综合征成年患者抗青光眼手术后并发白内障手术治疗1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2021.396

摘要/Abstract

摘要： 目的观察1例既往确诊Blau综合征11年的成年患者先后出现多种眼部病变后手术治疗的效果,为规范化诊疗、围手术期管理提供思路及参考。方法通过报告1例Blau综合征成年患者病程中先后出现双眼葡萄膜炎、双眼继发性闭角型青光眼、双眼并发性白内障,并分别于2016年左眼行青光眼阀管植入+异体巩膜移植+前房成形+瞳孔再造术、2020年行左眼超声乳化白内障吸除联合人工晶状体植入及虹膜周边切除术的病例,分析和总结Blau综合征患者并发性白内障的临床诊疗思维、围手术期管理等。结果患者术后3个月、6个月复查视力明显提高,眼压正常,前房中深,虹膜周切口通畅,人工晶状体位正。结论 Blau综合征患者的眼部病变需要早期、持续的观察和监测,及时给予规范合理的诊疗后患者可保留足够的视力以保障生活质量。

关键词: Blau综合征, 葡萄膜炎, 白内障, 青光眼, 超声乳化术

Abstract: Objective To observe the effect of surgical treatment of an adult patient with BLAU syndrome diagnosed in the past 11 years who developed a variety of ocular lesions successively, providing guidance and reference for standardized diagnosis and treatment, and perioperative management. Methods This is a case report of 1 adult BLAU syndrome patient who, in the course of the disease, developed binocular uveitis, binocular secondary angle-closure glaucoma, and binocular concurrent cataract. In 2016 his left eye received a glaucoma valve tube implantation, allograft sclera transplantation, anterior chamber remodeling, and pupil reconstruction. In 2020, phacoemulsification of the left eye combined with intraocular lens implantation and peri-iridectomy were performed. In this paper an analysis and summary of the clinical diagnosis, treatment conception and perioperative management of concurrent cataracts in a patient with Blau syndrome is presented. Results Three and six months after the operation, the patient's visual acuity improved significantly, her intraocular pressure returned to normal, the anterior chamber was deep, the peri-iris incision was smooth, and the intraocular lens was in the right position. Conclusion Ocular lesions of patients with Blau syndrome require early and continuous observation and monitoring. After timely, standardized, and well-considered diagnosis and treatment, patients can maintain enough vision to sustain their quality of life.

Key words: Blau syndrome, Uveitis, Cataract, Glaucoma, Phacoemulsification

中图分类号:

R775.3

石博影,梁皓,李一洪,唐东永. Blau综合征成年患者抗青光眼手术后并发白内障手术治疗1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 60-65.

SHI Boying, LIANG Hao, LI Yihong, TANG Dongyong. Surgical treatment of a cataract complicated by anti-glaucoma surgery in an adult patient with Blau syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(6): 60-65.

参考文献

[1] Blau EB. Familial granulomatous arthritis, iritis, and rash[J]. J Pediatr, 1985, 107(5): 689-693. doi:10.1016/S0022-3476(85)80394-2.
[2] Li C, Zhang J, Li S, et al. Gene mutations and clinical phenotypes in Chinese children with Blau syndrome[J]. Sci China Life Sci, 2017, 60(7): 758-762. doi: 10.1007/s11427-017-9090-6.
[3] Kaufman KP, Becker ML. Distinguishing Blau Syndrome from Systemic Sarcoidosis[J]. Curr Allergy Asthma Rep, 2021, 21(2): 10. doi: 10.1007/s11882-021-00991-3.
[4] Chauhan K, Michet C. A case of blau syndrome[J]. Case Rep Rheumatol, 2014:216056. doi: 10.1155/2014/216056.
[5] Sarens IL, Casteels I, Anton J, et al. Blau syndrome-associated uveitis: preliminary results from an international prospective interventional case series[J]. Am J Ophthalmol, 2018, 187: 158-166. doi:10.1016/j.ajo.2017.08.017.
[6] Blau EB. Familial granulomatous arthritis, iritis, and rash[J]. J Pediatr, 1985, 107(5): 689-693. doi:10.1016/S0022-3476(85)80394-2.
[7] Tromp G, Kuivaniemi H, Raphael S, et al. Genetic linkage of familial granulomatous inflammatory arthritis, skin rash, and uveitis to chromosome 16[J]. Am J Hum Genet, 1996, 59(5): 1097-1107.
[8] Sfriso P, Caso F, Tognon S, et al. Blau syndrome, clinical and genetic aspects[J]. Autoimmun Rev, 2012, 12(1): 44-51. doi:10.1016/j.autrev.2012.07.028.
[9] Rosé CD, Pans S, Casteels I, et al. Blau syndrome: cross-sectional data from a multicentre study of clinical, radiological and functional outcomes[J]. Rheumatology(Oxford), 2014, 54(6): 1008-1016. doi:10.1093/rheumatology/keu437.
[10] 李维超, 刘力, 尹晶, 等. Blau综合征2例[J]. 中华实用儿科临床杂志, 2018, 33(11): 869-870. doi:10.3760/cma.j.issn.2095-428X.2018.11.021. LI Weichao, LIU Li, YIN Jing, et al. Two cases report of Blau syndrome[J]. Chinese Journal of Applied Clinical Pediatrics, 2018, 33(11): 869-870. doi:10.3760/cma.j.issn.2095-428X.2018.11.021.
[11] 刘力, 赵倩倩, 李崇巍, 等. 儿童Blau综合征1例报告[J]. 中国实用儿科杂志, 2015, 30(12): 957-958. doi:10.7504/ek2015120621. LIU Li, ZHAO Qianqian, LI Chongwei, et al. One case of Blau syndrome in children[J]. Chinese Journal of Practical Pediatrics, 2015, 30(12): 957-958. doi:10.7504/ek2015120621.
[12] 李彩凤, 张俊梅, 李士朋, 等. 中国儿童Blau综合征患者基因突变及临床表型研究[J]. 中国科学: 生命科学, 2018, 48(9): 962-966. LI Caifeng, ZHANG Junmei, LI Shipeng, et al. Gene mutations and clinical phenotypes in Chinese children with Blau syndrome[J]. Scientia Sinica(Vitae), 2018, 48(9): 962-966.
[13] 李彩凤. 儿童Blau综合征研究进展[J]. 中国实用儿科杂志, 2018, 33(1): 26-29. doi:10.19538/j.ek2018010608. LI Caifeng. Advances in research of Blau syndrome of children[J]. Chinese Journal of Practical Pediatrics, 2018, 33(1): 26-29. doi:10.19538/j.ek2018010608.
[14] 王增智. 免疫抑制对非感染性葡萄膜炎的治疗作用及对细胞因子的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 64-67. doi: 10.6040/j.issn.1673-3770.0.2015.259. WANG Zengzhi. Immunosuppressive treatment for non-infectious uveitis and its effect on cytokines[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2015, 29(6): 64-67. doi: 10.6040/j.issn.1673-3770.0.2015.259.
[15] Xiang HT, Zhang T, Chen MP, et al. NOD2/CARD15 gene mutation identified in a Chinese family with Blau syndrome[J]. Mol Vis, 2012, 18: 617-623.
[16] Sarens IL, Casteels I, Anton J, et al. Blau syndrome-associated uveitis: preliminary results from an international prospective interventional case series[J]. Am J Ophthalmol, 2018, 187: 158-166. doi:10.1016/j.ajo.2017.08.017.
[17] 杨洪波, 杨向红. 葡萄膜炎并发白内障手术治疗的临床观察[J]. 眼科新进展, 2015, 35(9): 873-875. doi:10.13389/j.cnki.rao.2015.0238. YANG Hongbo, YANG Xianghong. Clinical observation of surgical treatment for uveitis complicated with cataract[J]. Recent Advances in Ophthalmology, 2015, 35(9): 873-875. doi:10.13389/j.cnki.rao.2015.0238.
[18] 吴小玲, 陈晓雅, 谭丽容, 等. 白内障手术患者术后发生感染性眼内炎相关因素和围术期护理[J]. 中华医院感染学杂志, 2018, 28(4): 578-581. doi:10.11816/cn.ni.2018-173151. WU Xiaoling, CHEN Xiaoya, TAN Lirong, et al. Risk factors and perioperative nursing of infectious endophthalmitis after cataract surgery[J]. Chinese Journal of Nosocomiology, 2018, 28(4): 578-581. doi:10.11816/cn.ni.2018-173151.
[19] 朱江, 孙红艳, 吴艳, 等. 超声乳化人工晶状体植入治疗葡萄膜炎并发性白内障[J]. 国际眼科杂志, 2016, 16(10): 1933-1936. doi:10.3980/j.issn.1672-5123.2016.10.38. ZHU Jiang, SUN Hongyan, WU Yan, et al. Observation on phacoemulsification and intraocular lens implantation surgical intervention of complicated cataract in patients with uveitis[J]. International Eye Science, 2016, 16(10): 1933-1936. doi:10.3980/j.issn.1672-5123.2016.10.38.
[20] Aravind Harapriya, Eliza Anthony, 郑楠. 葡萄膜炎患者白内障手术的治疗[J]. 实用防盲技术, 2019, 14(2): 47-48. doi:10.3969/j.issn.1673-3835.2019.02.001.
[21] 汤代文, 荣瑜. 超声乳化白内障吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障的临床研究[J]. 临床眼科杂志, 2017, 25(4): 339-341. doi:10.3969/j.issn.1006-8422.2017.04.018. TANG Daiwen, RONG Yu. Phacoemulsification and intraocular lens implantation combined with trabeculectomy in the treatment of primary angle-closure glaucoma and cataract[J]. Journal of Clinical Ophthalmology, 2017, 25(4): 339-341. doi:10.3969/j.issn.1006-8422.2017.04.018.
[22] 李锐, 李勇, 谢洪涛, 等. 眼压波动对人工晶体植入术患者眼底黄斑及视盘血流密度的影响分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 89-92. doi: 10.6040/j.issn.1673-3770.0.2019.280. LI Rui, LI Yong, XIE Hongtao, et al. Effects of intraocular lens implantation and postoperative intraocular pressure fluctuations on the fundus macular and optic disc vascular density[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 89-92. doi: 10.6040/j.issn.1673-3770.0.2019.280.
[23] 蒋博, 张永鹏, 李继鹏, 等. 以慢性葡萄膜炎首诊的Blau综合征一例[J]. 中华眼科杂志, 2019, 55(7): 543-545. doi:10.3760/cma.j.issn.0412-4081.2019.07.013.
[24] Caso F, Costa L, Rigante D, et al. Caveats and truths in genetic, clinical, autoimmune and autoinflammatory issues in Blau syndrome and early onset sarcoidosis[J]. Autoimmun Rev, 2014, 13(12): 1220-1229. doi:10.1016/j.autrev.2014.08.010.
[25] Suresh S, Tsui E. Ocular manifestations of Blau syndrome[J]. Curr Opin Ophthalmol, 2020, 31(6): 532-537. doi:10.1097/ICU.0000000000000705.

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