累及眼部的Stevens-Johnson综合征(附22例分析)

目的 :对 2 2例累及眼部的Stevens Johnson综合征 (SJS)作一初步临床分析。方法 :收集 1990～ 2 0 0 0住院的SJS病例 10 5例。回顾性分析其中眼部受累的患者 2 2例 (占 2 0 95 % )。根据致敏药物、发病前所患疾病、临床表现、实验室检查总结分析其可能的病因、眼部表现规律及治疗。结果 :累及眼部的 2 2例SJS病人中 ,肯定或可能是药物过敏引起的占 86 3 6% ,其中 ,抗生素类占 45 45 %。眼部充血是最常见的体征占 10 0 % ,有 5 0 %的病人结膜和 /或角膜形成假膜 ,视力下降占 3 1 82 %。眼部治疗主要是应用抗感染和人工泪液治疗。结论 :药物过敏是SJS最常见的原因。以结膜充血和假膜形成为特征的卡他性结膜炎是SJS眼部受累的最常见表现 ,重者可导致视力下降 ,早期合理的眼部治疗对预防晚期并发症非常重要。     

13例硬皮病眼部表现临床分析

目的 探讨硬皮病有眼部表现患者的临床特点。设计 回顾性病例系列。研究对象 2008年12月至2013年2月北京同仁医院风湿免疫科住院的13例伴眼部受累硬皮病患者。方法 回顾性分析13例累及眼部的硬皮病患者的临床资料,总结该病临床及实验室特点。主要指标 硬皮病患者的各种眼部表现占总病例数的百分比。结果 13例硬皮病患者均为女性;眼部受累的平均发病年龄为（43±12.2）岁,硬皮病平均病程（6.1±5.1）年,眼病平均病程（1.4±1.9）年。系统型硬皮病11例（84.6%）;局限型硬皮病2例（15.4%）。以眼部症状为首发表现者7例（53.8%）。干燥性角结膜炎7例（53.8%）,眼睑皮肤改变3例（23.1%）和青光眼3例（23.1%）为常见眼部表现;其他表现依次为视神经炎、角膜炎、虹睫炎（各2例,占15.4%）,巩膜炎、白内障、葡萄膜炎、中心性浆液性脉络膜视网膜病变、眼球内陷、泪腺炎（各1例,占7.7%)。未发现眼部受累与全身表现及实验室指标相关。结论 各型硬皮病均可出现眼部受累,其中以系统型硬皮病为主。硬皮病眼部表现多样,受累范围广泛,其中以干燥性角结膜炎最常见。（眼科, 2015, 24： 317-319, 360）     

Stevens-Johnson综合征和中毒性表皮松解症的病理损害、眼部表现及治疗进展

Stevens-Johnson综合征(Stevens-Johnson syndrome,SJS)及中毒性表皮(坏死)松解症(toxic epidermal necrolysis,TEN)这两种药物不良反应能严重威胁到患者的生命安全,其均由机体免疫反应引起,两者临床症状非常相似,且互有交叉.两者均表现出全身不适、高热、皮肤疱疹及斑丘疹,常伴有黏膜损伤以及眼部损伤等.SJS与TEN引起的眼部损伤临床治疗棘手,治疗不及时容易致盲且预后差.主要病理环节为外周血液中角化细胞表面所表达的Fas受体与单个核细胞分泌的可溶性Fas配体之间发生相互作用,使角化细胞迅速凋亡、表皮损伤,临床症状逐渐明显.治疗方法包括一般性治疗(系统支持治疗、皮肤黏膜分泌物或伪膜清理、他克莫司等)和特异性治疗(如糖皮质激素、环磷酰胺等特异性药物)和眼部损伤治疗(视病情给予羊膜移植、结膜瓣覆盖、角膜移植、人工角膜及眼表重建等手术治疗).     

首发于眼结膜的淋巴瘤MRI特征分析

目的 分析眼结膜淋巴瘤影像学表现,了解其MRI特征。设计 回顾性病例系列。研究对象 首诊于北京同仁医院眼科的21例眼结膜淋巴瘤患者。方法 分析21例患者临床表现、MRI影像学特征和病理诊断。主要指标 眼结膜淋巴瘤原发部位、范围及MRI特征。结果 21例（25眼）患者中,病变位于上睑结膜4眼,下睑结膜7眼,上下睑结膜同时受累14眼;病变局限于结膜或眼睑19眼,侵及眼眶6眼（2眼累及肌锥外间隙、眼外肌和泪腺,3眼累及眼上肌群,1眼累及Tenon囊及视神经）;边界欠清晰15眼,清晰10眼;17眼病变包绕眼球生长,8眼表现为眼球前部结节影。与眼外肌相比,所有病变T1WI均显示等信号,T2WI 18眼显示等信号,7眼显示稍高信号;18眼信号均匀,7眼不均匀或欠均匀。13例（15眼）进行增强扫描的病变均呈轻至中度强化,强化均匀8眼,不均匀7眼。7例（8眼）行动态增强扫描的病变,动态增强曲线表现为平台型6眼,流出型2眼。结论 眼结膜淋巴瘤MRI特征是呈等T1等或稍高T2信号,信号多均匀,增强呈轻中度强化,动态增强曲线呈平台型。（眼科,2013, 22：320-323）     

Stevens-Johnson综合征眼部病变的治疗

Stevens-Johnson综合征是一种主要累及全身皮肤和黏膜的自身免疫性疾病,80％以上的患者眼部受累,累及眼睑、结膜和角膜等。患者一旦出现眼部症状,应立即给予积极正规的眼科治疗。在急性期要停用一切可疑药物,使用免疫抑制剂、糖皮质激素、免疫球蛋白等药物抑制免疫炎症反应。慢性期主要针对干眼症状采取相应措施,如使用人工泪液等润滑剂、颌下腺移植、配戴巩膜接触镜,甚至是睑缘缝合。后遗症期要通过手术重建眼表正常的解剖和功能,手术方式有羊膜移植、角膜缘干细胞移植、口腔黏膜上皮移植、角膜移植或联合移植。严重者也可以尝试人工角膜来重建眼表并恢复视力。     

与获得性免疫缺陷综合征相关的卡波济肉瘤在眼部的临床表现

目的 提高对获得性免疫缺陷综合征(AIDS)患者眼部卡波济肉瘤(KS)的认识及诊断处理能力。方法 回顾系列病例研究。回顾分析10例AIDS并发KS患者的眼部临床表现及其治疗随访结果。结果 10例患者均为汉族男性;年龄21~71岁,平均(38.60±15.66)岁;病程10 d~7个月,平均(2.68±2.41)个月。CD4 ⁺T淋巴细胞2~348 个/μL,平均(62.30±105.86)个/μL。临床表现:眼睑合并结膜KS4 例、结膜KS 4例、眼睑KS 2例。眼睑KS表现为紫黑色局部结节,质韧,边界不清,无移动性,无压痛;结膜KS呈暗红色,片状。仅1例为单纯眼部KS,余9例均为全身多发性KS,累及皮肤、口腔、淋巴结、肺、肝、心包等。治疗:1例单纯眼部睑结膜KS未合并其他部位肿瘤患者行手术切除,高效抗逆转录病毒治疗(HAART),未行化学治疗(简称化疗),观察1年未复发;余9例均给予HAART和多柔比星脂质体或紫杉醇化疗。2例治疗过程中全身衰竭死亡,8例患者随访8~19个月,平均(12.50±4.28)个月,眼部病变6例完全缓解,2例部分缓解。结论 随着HIV/AIDS感染日益增多,汉族人种AIDS患者KS发病逐渐增多,且多为多器官累及。HAART合并化疗可提高患者眼部病变缓解率。     

与获得性免疫缺陷综合征相关的卡波济肉瘤在眼部的临床表现

目的提高对获得性免疫缺陷综合征(AIDS)患者眼部卡波济肉瘤(KS)的认识及诊断处理能力。方法回顾系列病例研究。回顾分析10例AIDS并发KS患者的眼部临床表现及其治疗随访结果。结果10例患者均为汉族男性;年龄21~71岁,平均(38.60±15.66)岁;病程10 d^7个月,平均(2.68±2.41)个月。CD4^+T淋巴细胞2~348个/μL,平均(62.30±105.86)个/μL。临床表现:眼睑合并结膜KS4例、结膜KS 4例、眼睑KS 2例。眼睑KS表现为紫黑色局部结节,质韧,边界不清,无移动性,无压痛;结膜KS呈暗红色,片状。仅1例为单纯眼部KS,余9例均为全身多发性KS,累及皮肤、口腔、淋巴结、肺、肝、心包等。治疗:1例单纯眼部睑结膜KS未合并其他部位肿瘤患者行手术切除,高效抗逆转录病毒治疗(HAART),未行化学治疗(简称化疗),观察1年未复发;余9例均给予HAART和多柔比星脂质体或紫杉醇化疗。2例治疗过程中全身衰竭死亡,8例患者随访8~19个月,平均(12.50±4.28)个月,眼部病变6例完全缓解,2例部分缓解。结论随着HIV/AIDS感染日益增多,汉族人种AIDS患者KS发病逐渐增多,且多为多器官累及。HAART合并化疗可提高患者眼部病变缓解率。     

眼部Wegener肉芽肿17例临床分析

目的 分析累及眼部的Wegener肉芽肿（Wegener's granulomatosis, WG）患者的临床资料, 提高对本病的认识。设计 回顾性病例系列。研究对象 2000年1月至2014年6月武警总医院眼眶病研究所收治的病理诊断为WG的患者17例。方法 回顾性分析患者的病历资料。记录分析眼部及全身临床表现、实验室检查、影像学特征及预后。主要指标 眼部及全身临床表现、实验室检查、影像学特征及预后。结果 17例患者中,女性7例。发病年龄17~65岁,平均（38.4±13.2）岁。眼部多个部位均可能受累, 包括眼球、泪腺、眼外肌、视神经及眶周软组织等。8例患者行抗中性粒细胞胞浆抗体（ANCA）检查,7例胞浆型ANCA（c-ANCA）阳性,其中1例c-ANCA和核周型ANCA（p-ANCA）均阳性。所有患者均行眶部占位病变切除手术,术后病理学检查,主要病理改变为坏死性肉芽肿和/或血管炎。经糖皮质激素或联合应用免疫抑制剂或联合应用局部放疗效果较好（8/11）,随访期间2例患者术后复发,仍给予上述治疗达到临床缓解。2例患者死于肾功能衰竭,1例患者死于呼吸衰竭。结论 WG是一种累及多系统的致死性疾病,可以累及眼的任何部位,ANCA检查有助于明确诊断,但仍需病理检查明确诊断。应用糖皮质激素、免疫抑制剂以及局部放疗可取得较好效果。     

联合或不联合板层角膜移植的结膜瓣移植治疗巩膜坏死

目的介绍结膜瓣移植治疗眼部烧伤和眼科手术后巩膜缺血坏死的手术方法,观察其临床疗效。方法回顾性病例研究。2007年1月至2012年3月,共13例眼部烧伤和眼科手术后巩膜缺血坏死、溶解的患者在山东省眼科医院接受了结膜瓣移植,其中碱烧伤4例．热烧伤6例．翼状胬肉切除手术后巩膜坏死3例。对所有患者行带蒂结膜瓣转位或游离结膜瓣移植术治疗,其中4例行单纯结膜瓣移植,2例联合部分板层角膜移植（LK）术,6例联合羊膜移植（AMT）术,1例联合LK和AMT术。随诊3—24个月,对手术后巩膜坏死和结膜瓣存活等情况进行观察。结果移植的结膜瓣1周内血运差、色苍白,1周后逐渐出现充血表现,2周拆除结膜瓣缝线后充血症状逐渐减轻。13例患者结膜瓣均愈合良好,巩膜坏死控制。至最后一次随访,2例角膜透明,3例角膜植片透明,1例角膜斑翳．7例角膜血管化。结论结膜瓣移植（或联合LK和AMT）治疗眼部烧伤和眼科手术后巩膜坏死在临床上安全有效,能够较好地解决巩膜穿孔的风险,为后续治疗提供一个相对稳定的眼部环境。     

眼眶炎性假瘤所致的眶尖综合征

目的　探讨眼眶炎性假瘤所致的眶尖综合征的临床特点和治疗等。方法　回顾分析我院自1 978年 1月到 1 998年 1 2月眼眶炎性假瘤病例 1 94例 ,其中 9例有典型的眶尖综合征表现 :患眼向各个方向运动受限或眼球固定 ,上睑下垂 ,调节麻痹 ,瞳孔散大 ,下睑皮肤麻木和视力下降或丧失等。治疗方法包括全身口服皮质激素、局部放射治疗、手术切除和上述方法联合治疗等。结果　 9例病人中 ,6例有眼球突出 ,5例有眼眶疼痛与结膜或眼睑充血。 5例经全身激素治疗后 ,4例视力有提高 ;3例上睑下垂基本消失 ,2例睑裂部分开大 ;5例病人眼球运动均恢复正常。 4例经开眶手术活检后用全身激素治疗 ,1例视力恢复正常 ,上睑下垂消失 ,眼球运动恢复正常 ;3例病情无好转。结论　眼眶炎性假瘤是眶尖综合征的常见原因之一 ,约一半病人没有眼部疼痛与充血 ,全身激素治疗效果好 ,其与眼眶恶性淋巴瘤的鉴别诊断十分重要     

Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis: acute ocular manifestations, causes, and management

PURPOSE: To study the acute ocular/cutaneous manifestations, causes, and management of the erythema multiforme (EM)/Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) disease spectrum. METHODS: We retrospectively reviewed the medical records of all EM/SJS/TEN patients hospitalized at National Cheng Kung University Hospital in Taiwan between 1988 and 2004. Demographic data, medical/medication histories, ocular/mucocutaneous manifestations, management, sequelae, and recurrence were analyzed. RESULTS: A total of 207 patients 2 months to 95 years of age were hospitalized with 213 episodes/attacks of EM/SJS/TEN. Medications were the most common cause of any condition: for SJS, carbamazepine was most common; for EM or TEN, allopurinol was most common. In 128 of the 213 attacks (60.1%; 126 patients), ocular manifestations were documented during hospitalization, occurring more often in those with SJS (81.3%) or TEN (66.7%) compared with those with EM (22.7%; P < 0.01). The most frequent ocular treatments were topical steroids, topical antibiotics, and lubricants. Overall, 24 (18.8%) of 128 acute attacks in 126 patients were followed by ocular sequelae, mostly dry eye. Five (2.4%) of the 207 patients sustained a total of 6 recurrent attacks, in 3 cases because of the same medication. CONCLUSIONS: Ocular manifestations occur in a high proportion of patients with EM/SJS/TEN. The most frequent causes were carbamazepine and allopurinol. A careful medication history should be obtained from these patients. Ophthalmic consultation, evaluation, and management are mandatory.     

The ophthalmologist's role in the management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis

Stevens-Johnson syndrome (SJS) and its more severe variant, toxic epidermal necrolysis (TEN), are relatively rare but have high mortality rates. Survivors are frequently afflicted with severe blinding ocular surface diseases. Recent literature in the areas of ophthalmology and dermatology illustrate that the ophthalmologist's role should no longer be considered secondary in the acute management of SJS/TEN. Accurately differentiating SJS or TEN from erythema multiforme majus (EMM) at the onset of the disease is important, because the management approach to these disease entities differs. Systemic cyclosporine and intravenous immunoglobulin have shown some potential as treatments for SJS/TEN, but their efficacies remain controversial. Amniotic membrane transplantation and intravenous corticosteroid pulse therapy at the acute stage have shown promise for preventing late sight-threatening cicatricial complications. An improved staging system for the ocular surface involvement of acute SJS/TEN, as well as better understanding of the underlying destructive pathogenic mechanism, should further improve our ability to predict ocular involvement and develop new therapeutics to abort destructive processes at the acute stage.     

Toll-like receptor 3 gene polymorphisms in Japanese patients with Stevens-Johnson syndrome

BACKGROUND and AIM: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute-onset mucocutaneous diseases induced by infectious agents and/or inciting drugs. Given the association between the onset of SJS/TEN and infections, the possibility that there is an association between SJS/TEN and a disordered innate immune response was considered. The first line of defence against infection is comprised of evolutionarily conserved sets of molecules, the Toll-like receptors (TLRs). TLR3 recognises double-stranded RNA associated with viral infections. METHODS: The Japanese single-nucleotide-polymorphism (JSNP) database reports 7 polymorphisms consisting of 7 SNPs in the human TLR3 gene; 3 of the 7 SNPs are coded in exon regions, (ie, 293248A/G, 293391A/G and 299698T/G), and the other 4 are coded in intron regions, (ie, 294440G/C, 294732C/T, 208036T/C and 298054C/T). These 7 SNPs were analysed in 57 Japanese patients with SJS/TEN with ocular surface complications and in 160 Japanese healthy controls. RESULTS: SNP 299698T/G and the genotype patterns of 293248A/A and 299698T/T were strongly associated with SJS/TEN. CONCLUSION: The results suggest that polymorphisms in the TLR3 gene could be associated with SJS/TEN in the Japanese population.     

Bilateral Microbial Keratitis in Highly Active Antiretroviral Therapy-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Case Series

Purpose: To report three cases of bilateral microbial keratitis in eyes with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by highly active antiretroviral therapy (HAART) in patients of acquired immune deficiency syndrome (AIDS). Methods: A case series. Results: A detailed clinical examination and systemic review of all the three patients on HAART was performed. While one manifested with the more severe variant of TEN, two of these patients presented with SJS with ocular involvement. Despite withdrawal of nevirapine, the ocular surface disorder persisted. The entailing chronic epitheliopathy along with the compromised immune status led to the development of secondary microbial keratitis in all these cases. Conclusions: The immune reconstitution occurring as a response to the antiretroviral therapy may potentially increase immunologically mediated diseases like SJS and TEN, which in turn may predispose the eye to develop corneal ulcer.     

Association of combined IL-13/IL-4R signaling pathway gene polymorphism with Stevens-Johnson syndrome accompanied by ocular surface complications

PURPOSE: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute-onset mucocutaneous diseases induced by infectious agents or inciting drugs. The authors previously reported an association between SJS/TEN and IL-4R gene polymorphism that is essential for IL-4 and IL-13 signaling. To examine IL-4 and IL-13 gene polymorphisms and the combination of these polymorphisms with IL-4R polymorphism, the authors performed polymorphism analysis. METHODS: In 76 Japanese SJS/TEN patients with ocular surface complications and 160 healthy controls, the authors analyzed polymorphisms of the promoter -590C/T in the IL-4 gene and of the promoter -1111C/T and Arg110Gln in the IL-13 gene and assessed Gln551Arg in the IL-4R gene. Because Arg110Gln affects serum IL-13, plasma IL-13 levels were also examined. RESULTS: In the SJS/TEN patients, the Arg110Gln SNP of IL-13 was significantly associated with the disease, and the frequency of Arg110 alleles was significantly higher than that in the controls. Plasma IL-13 tended to be lower in SJS/TEN patients than in the controls. Analysis of the genotype pattern of IL-4R SNP Gln551Arg and IL-13 SNP Arg110Gln showed that the Gln551Gln(A/A)-Arg110Arg(G/G) genotype pattern was also associated with SJS/TEN. CONCLUSIONS: IL-13 gene polymorphisms might be associated with SJS/TEN with ocular surface complications. The present findings suggest that SJS/TEN is different from allergic diseases such as atopy and asthma because the ratio of each allele in the IL-13 SNP Arg110Gln was the opposite of the ratio in those diseases. They also reveal that combined polymorphisms in the IL-13/IL-4R signaling pathway were associated with SJS/TEN with ocular surface complications.     

The natural history of Stevens Johnson syndrome: patterns of chronic ocular disease and the role of systemic immunosuppressive therapy

OBJECTIVE: To characterize patterns of chronic ocular disease in patients with Stevens-Johnson syndrome (SJS) and its variant toxic epidermal necrolysis (TEN), and to describe their response to treatment. METHODS: Retrospective case series. A review of hospital records of 30 patients (60 eyes) with ocular manifestations of SJS or TEN was carried out. The principal outcome measure was to identify and classify the patterns of chronic ocular disease in SJS and TEN. The secondary outcome measure was the response to treatment. RESULTS: Patterns of chronic ocular disease observed after the acute episode included: mild/moderate SJS, severe SJS, ocular surface failure (SJS-OSF), recurrent episodic inflammation (SJS-RI), scleritis (SJS-S) and progressive conjunctival cicatrisation resembling mucous membrane pemphigoid (SJS-MMP). The median follow-up was 5 years (range 0-29). 19 patients (29 eyes (48%)) developed SJS-OSF, SJS-RI, SJS-S or SJS-MMP during follow-up. SJS-OSF was present in 12 patients (18 eyes (30%)). In 5 patients (eight eyes) this developed 1 year after the acute illness, without any further inflammatory episodes; it was associated with SJS-RI in 1 patient (2 eyes), with SJS-RI and SJS-S in 1 patient (1 eye), with SJS-S in 1 patient (1 eye) and with SJS-MMP in 4 patients (6 eyes). Episodes of SJS-RI occurred in 4 patients (7 eyes (12%)). The median time from acute disease to the first episode of SJS-RI was 8.5 years (range 5-63). SJS-S developed in 2 patients (4 eyes (7%)), of which 2 eyes subsequently developed SJS-OSF. SJS-MMP developed in 5 patients (10 eyes (16.6%)). The median duration from the acute stage to the diagnosis of SJS-MMP was 2 years (range 1-14). Immunosuppressive therapy successfully controlled inflammation in 10/10 patients with SJS-MMP, SJS-RI or SJS-S. CONCLUSION: Ocular disease in SJS/TEN is not limited solely to the sequelae of the acute phase illness. Patients and physicians need to know that ocular disease progression, due to surface failure and/or acute inflammatory conditions, may occur at variable periods following the acute disease episode. Recognition of this, and prompt access to specialist services, may optimise management of these uncommon patterns of disease in SJS.     

High-dose intravenous immunoglobulin in the treatment of toxic epidermal necrolysis: a study of ocular benefits

PURPOSE: To compare acute ocular complications of toxic epidermal necrolysis (TEN) following treatment with high-dose human intravenous immunoglobulin (IVIG) with a historical cohort not treated with IVIG. METHODS: Retrospective, historically controlled study. In all, 10 consecutive patients with TEN (treatment cohort) presenting between 1 July 2001 and 30 June 2002. Totally, 18 consecutive patients with TEN (historical cohort).SettingTan Tock Seng Hospital, Singapore. The treatment cohort received high-dose IVIG (2 g/kg body weight over 2 days). Patients' records were retrospectively reviewed for their demographic characteristics, causative drug, treatment, ocular involvement (if any, as assessed by an ophthamologist), and its severity. The historical cohort comprised patients coded with a diagnosis of TEN (ICD Code 695.1) between 1 July 1995 and 30 June 2001. RESULTS: Nine (90%) of 10 patients treated with IVIG had ocular involvement. Phenytoin was the implicated drug in three (37.5%) patients. Of the nine patients, 1 died of septic shock. Of the eight survivors, IVIG was initiated immediately upon onset of TEN as all the patients were hospitalized by the time of onset of an exanthema. Acute ocular complications were mild in two (25%) (lid oedema or mild conjunctival injection), moderate in four (50%) (pseudomembranes) and severe in two (25%) (nonhealing epithelial defect with visual loss and symblepharon). In total, 10 (55.6%) of 18 patients in the historical cohort with TEN had acute ocular involvement. Two patients died. Ocular involvement in survivors was mild in five (62.5%) cases and moderate in three (37.5%), with no severe cases. CONCLUSIONS: IVIG did not appear to reduce the severity of visually significant ocular complications. Larger studies are needed to confirm this finding.     

Strong association between HLA-A*0206 and Stevens-Johnson syndrome in the Japanese

PURPOSE: To investigate the association between HLA class I antigens and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) with ocular complications in Japanese. DESIGN: Case-control study. METHODS: We examined the histocompatibility antigen genes HLA-A, -B, and -C of 40 Japanese SJS/TEN patients with ocular complications and 113 healthy Japanese volunteers by polymerase chain reaction amplification and subsequent hybridization with sequence-specific oligonucleotide probes (PCR-SSO). RESULTS: We clarified that HLA-A*0206 is strongly associated with SJS/TEN with ocular complications in the Japanese. CONCLUSIONS: Because this finding is completely different from data reported elsewhere on Taiwanese Han Chinese patients and Caucasian patients, it suggests strong ethnic differences in the HLA-SJS association and points to the need for studies in other ethnic populations in order to obtain a global picture.     

曲伏前列素滴眼液抗青光眼治疗中对眼表影响的观察

目的：探讨局部应用抗青光眼药物曲伏前列素滴眼液对患者泪膜功能的影响。方法：选取原发性开角型青光眼或高眼压患者18例32眼。患者均局部用曲伏前列素滴眼液,每晚滴1次。用药前及用药后1,2,3mo行症状评分及基础泪液分泌量测定（Schirmer Ⅰ test ,SⅠt）、角膜荧光素染色（corneal fluorescein staining,FL）、泪膜破裂时间（tear break-up time, BUT）。结果：全部患者用药前患者症状评分、FL的平均值为1.34±1.56,0.44±0.73,用药后1,2,3mo分别为2.75±1.63,1.08±0.84; 5.10±1.68,1.53±0.67; 6.33±1.40,1.98±0.50。用药后1,2,3mo患者症状评分、FL均显著高于用药前（P=0.00）,且逐渐增加。全部患者用药前患者症状BUT,SⅠt的平均值为（7.76±0.92s）,（8.47±2.73mm/5min）,用药后1,2,3mo分别（7.08±1.15s）,（7.73±3.44mm/5min）;（5.59±1.33s）,（6.82±3.05mm/5min）;（4.29±1.87s）,（6.04±3.15mm/5min）。用药后1,2,3mo患者BUT 值和SⅠt值均显著低于用药前水平（P=0.00）,且逐渐减低。结论：短期使用曲伏前列素滴眼液即加重患者角膜刺激症状,泪膜稳定性下降, 泪液分泌减少。