TECD综合征的临床研究

目的：探讨TECD综合征的临床特征，病程转归以及致病因素。方法：（1）对25例临床诊断为TECD综合征的患者行眼前节检查，角膜厚度检查，角膜内皮细胞形态和数量以及眼压检查；（2）认定引起TECD综合征的化学物质。结果：（1）多数TECD综合征患者同时还伴有大片状或弥漫性虹膜缩，瞳孔开大强直和斑块状或颗粒状色素性KP。（2）电镜下发现TECD综合征患者的角膜内皮细胞和虹膜色素上皮细胞，其超微结构出现了明显的异常；（3）TECD综合征角膜内皮细胞的丢失率大，平均67．6％。（4）TECD综合征会导致角膜内皮细胞不可逆性的功能失代偿，形成永久性角膜水肿，大泡性角膜病变和瘢痕性角混膜混浊。（5）手术器械残留的消毒剂是导致TECD综合征的主要原因，13眼占52％。结论：（1）除了Breebaart等归纳的7个体征外，TECD综合征患者还伴有虹膜和瞳孔的异常表现。（2）TECD综合征具有发病速度快，病变范围广泛，预后较差等特征。（3）注意将手术器械残留的消毒剂冲洗干净是预防TECD的关键。

A clinical study of TECD syndrome

Objective: To discuss the clinical characteristics, the prognosis and the induce factors of the Toxic Endothelial Cell Destruction (TECD) syndrome. Methods: The following exams were undergone on 25 eyes of the patient with the diagnosis of TECD syndrome, physical checkup, thickness of cornea, morphologic and quantity exam, and the intraocular pressure. Some procedures were run so that to designated the harmful substances that can induce the chemical destruction to the corneal endothelium. Results: The new symptoms in most patients with TECD syndrome that were found in this data included lamellar dystrophy in iris, tetanization of pupil and granular pigment KP. Under electromicroscope, there were many obvious abnormalities of substructure in the corneal endothelium and iris. The mean loss rate of the corneal endothelium was 67.6%. TECD syndrome can induce the irreversible decompensation of corneal endothelium. The permanent corneal edema and bullous keratopathy would appear in the following days. The disinfectant that residue on the operative instruments were one of the most important factors that induce the TECD syndrome. Conclusions: Except of the seven symptoms concluded by Breebaart, there are also the abnormal performances of pupil and iris appear in TECD syndrome. The TECD syndrome appears very fast and extent process, and the unsatisfied prognosis. Washing the disinfectant that residue on the operative instruments is very critical to prevent the TECD syndrome.