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首页> 外文期刊>The New England journal of medicine >Bilateral corneal perforation
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Bilateral corneal perforation

机译：双侧角膜穿孔

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A 61-YEAR-OLD WOMAN WITH LONG-STANDING RHEUMATOID ARTHRITIS presented with the sensation that she had a foreign body in her right eye; she reported no symptoms in her left eye. The patient had systemic symptoms associated with her rheumatoid arthritis, with no synovitis, and was receiving treatment with naproxen. Evaluation revealed corneal perforations in both eyes, with iris prolapse, resulting in irregular pupils. She also had cataracts, probably long-standing, since she was unperturbed by her visual acuity — 20/400 in the right eye and 20/200 in the left eye (Panels A and B, respectively). Notably, the conjunctivas were uninjected. The erythrocyte sedimentation rate was 110 mm per hour. Oral steroids were started before the initiation of methotrexate, and corneal-patch grafting was performed. The anatomical integrity of both eyes was preserved, albeit with persistent defects in the iris (Panel C, right eye after surgical repair; Panel D, left eye after surgical repair), but acuity was limited to 20/150 in the right eye and 20/100 in the left eye owing to progressive cataracts. Cataract surgery was deferred until these issues were resolved. Corneal perforations are a surgical emergency. Progression may be prevented by the administration of immunosuppressive treatment directed at the underlying rheumatoid arthritis.
机译：一位61岁的类风湿关节炎患者长期站立，感觉右眼有异物。她的左眼没有任何症状。该患者有与类风湿关节炎相关的全身症状，无滑膜炎，正在接受萘普生治疗。评价显示两只眼睛都有角膜穿孔，虹膜脱出，导致瞳孔不规则。她还患有白内障，可能是长期存在的，因为她的视力不受干扰-右眼为20/400，左眼为20/200（分别为图A和图B）。值得注意的是，结膜未注射。红细胞沉降速率为每小时110mm。在开始甲氨蝶呤之前开始口服类固醇，并进行角膜贴片移植。尽管虹膜存在永久性缺陷（面板C，手术修复后的右眼;面板D，手术修复后的左眼），但保留了两只眼睛的解剖学完整性，但右眼和20眼的视力仅限于20/150由于进行性白内障，左眼为/ 100。白内障手术推迟到这些问题解决为止。角膜穿孔是外科急症。可以通过针对潜在类风湿关节炎的免疫抑制治疗来预防疾病进展。

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