High-Dose, Short-Term Chlorambucil for Treatment of Intractable Sympathetic Ophthalmia-A Case Report

病人為二十歲男性，因車禍導致右眼鈍挫傷，產生虹膜剝離(iridodialysis)及白內障，在接受水晶體移除及虹膜修補手術的五天後，手術傷口裂開而有虹膜脫出(iris prolapse)現象，兩個禮拜之後，交感性眼炎就發生了，而且發作的非常猛爆、發作幾天後，視力只剩手動30公分（右眼激發眼）及指數30公分（左眼交感眼）、開始我們以全身及局部類固醇治療，但經過一個半月，視力仍舊很差、並且只要類固醇稍微減量，症狀馬上明顯惡化、因此，我們採用了Howard H. Tesiler在1990年的報告，使用高劑量，短療程的Chlorambucil來治療，使用Chlorambucil三個月後，視力迅速恢復至：20/100（右眼）及20/20（左眼），而同時我們也能夠輕易地減少類固醇的量，在使用Chlorambucil的第十七週，白血球數目曾一度減少至臨界值2,400／立方毫米以下，但停用藥物以後即回升至正常，在我們兩年多追踪期間，並役有任何副作用產生，也役有復發跡象，Chlorambucil的總劑量是1,432毫克，總療程是17週。

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並列摘要

This 20 y/o male patient had a blunt trauma to his right eye in a traffic accident which led to iridodialysis and traumatic cataract. After ICCE+iridectomy procedure, uvea prolapse over limbal wound was noted at 5th post-op day. Two weeks after the episode, sympathetic ophthalmia (S.Q) occurred. The onset of S.O. was fulminent and the course was intractable. Visual acuity at first few days went downhill rapidly to MM/30cm (exciting eye) and c.f./30cm (sympathetic eye). Steroid therapy was given initially, but V.A still remained poor for 1.5 months and any attempt to tapering steroid resulted in relapse. Therefore, we adopted the high-dose, short-term chlorambucil regimen recommanded by Howard H Tessler (1990)(superscript (1)) after patient's consent. V.A was remarkably improving to 20/200 (exciting eye) and 20/20 (sympathetic eye) after 3 months of chlorambucil the rapy. In the meanwhile, steroid could be tapered smoothly. Decrease of WBC count was noted at 17th weeks but is reversible after discontinuing the regimen. No evidence of recurrence was noted. The total dose of chlorambucil is 1432mg and duration is 17 weeks.

並列關鍵字

sympathetic ophthalmia ； chlorambucil ； uvea prolapse ； exciting eye ； sympathetic eye

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High-Dose, Short-Term Chlorambucil for Treatment of Intractable Sympathetic Ophthalmia-A Case Report

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