目的探讨人工晶状体植入术后并发迟发性葡萄膜炎的可能机制。方法 320例(360眼)接受人工晶状体植入术的患者,观察患者手术后迟发性葡萄膜炎的发生情况,动态监测所有患者手术前和手术后的循环免疫复合物(CIC)水平变化情况,分析迟发性葡萄膜炎的发病诱因。结果术后6周内,11例(11眼)出现迟发性葡萄膜炎,发病率3.06%。经过局部及全身皮质类固醇激素治疗后,视力恢复情况良好。发生迟发性葡萄膜炎组患者的CIC水平明显高于未发生迟发性葡萄膜炎组患者(P〈0.05),11例(11眼)出现迟发性葡萄膜炎患者均为突然发生,7例为术后2周内劳累或用眼过度,2例为未按照医生叮嘱用药,1例为高度近视患者,1例为糖尿病患者。结论人工晶状体植入术后并发迟发性葡萄膜炎与植入体引发的免疫复合物沉积相关,术后良好休息、定期复查、避免过早停药和控制血糖可以有效降低迟发性葡萄膜炎的发病率,出现迟发性葡萄膜炎的患者经过及时有效激素治疗,效果满意。
Objective To explore possible mechanism of delayed uveitis after intraocular lens implantation. Methods There were 320 paitnets(360 eyes) receiving intraocular lens implantation, and their delayed uveitis condition after operation were observed. Changes of circulating immune complexes(CIC) before and after treatment were in dynamic detection for analysis of pathogenesis for delayed uveitis. Results In 6 weeks after operation, there were 11 cases(11 eyes) with delayed uveitis, and the morbidity was 3.06%. After local and general corticosteroid hormone treatment, their vision recovery was good. CIC level in delayed uveitis group was obviously higher than that in non-delayed uveitis group(P0.05). All the 11 cases(11 eyes) had acute delayed uveitis, there were 7 cases due to fatigue or excessive eye use after 2 weeks of operation, 2 cases due to disobedient of doctor order, 1 case due to high myopia, and 1 case due to diabetes mellitus. Conclusion Delayed uveitis after intraocular lens implantation is correlated with immune complex deposits of implantation. Morbidity of delayed uveitis can be reduced by postoperative rest, regular examination, long-term drug use, and blood glucose control. Timely and effective hormonotherapy can provide satisfactory effect in treating delayed uveitis.