Cataract surgery in a patient with bilateral necrotising scleritis and peripheral ulcerative keratitis associated with granulomatosis with polyangiitis (Wegener’s granulomatosis)

Svetlana Stanojlović; Selimir Glišić; Snežana Arandjelović; Tanja Kalezić; Bojana Dačić Krnjaja; Borivoje Savić

doi:10.2298/VSP181029013S

Svetlana Stanojlović University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia
Selimir Glišić Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia
Snežana Arandjelović University of Belgrade, Faculty of Medicine, Belgrade, Serbia;Institute for Allergology and Immunology, Clinical Centre of Serbia, Belgrade, Serbia
Tanja Kalezić University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia
Bojana Dačić Krnjaja University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia
Borivoje Savić Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP181029013S

Ključne reči: skleritis;, rožnjača, ulceracije;, granulomatoza sa poliangiitisom;, katarakta, ekstrakcija;, lečenje, ishod

Sažetak

Uvod. U radu je prikazan veoma redak slučaj operacije katarakte kod bolesnika sa ekstremnim, opsežnim prednjim stafilomom sklere koji je nastao nakon bilateralnog nekrotizujućeg skleritisa u sklopu granulomatoze sa poliangiitisom (GPA). Prikaz bolesnika. Muškarac, starosti od 61 godine, razvio je obostrani, progresivni nekrotizujući skleritis i periferni ulcerozni keratitis (PUK). Inflamacija je obuhvatila celu prednju polovinu bulbusa i periferiju rožnjače na oba oka. Nakon primene 3 pulsne doze metilprednizolona uz povećanje doze održavanja ciklofosfamida, inflamacija je sanirana u više od 90% površine nekrotične sklere u periodu od 8 nedelja. Sistemska steroidna terapija postepeno je redukovana tokom 6 meseci. Kao posledica teškog oblika nekrotizujućeg skleritisa i PUK-a došlo je do ekstremnog istanjenja sklere sa prolabiranjem uvealnog tkiva. Šest meseci nakon potpune remisije bolesti, urađena je nekomplikovana operacija katarakte na levom, jedinom funkcionalnom oku. Zaključak. Preoperativna i postoperativna kontrola inflamacije, pažljivo planiranje operacije i izbor hirurške tehnike od kritičnog su značaja za optimalan ishod operacije kod ovakvih bolesnika. Prema našem saznanju, fakoemulzifikacija kod bolesnika sa uvetičnom kataraktom i ekstremnim prednjim stafilomom do sada nije publikovana.

Biografije autora

Svetlana Stanojlović, University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia

Department for Corneal and External Eye Diseases

Selimir Glišić, Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia

Department for Cataract Surgery

Tanja Kalezić, University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia

Department for Corneal and External Eye Diseases

Bojana Dačić Krnjaja, University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia

Department for Corneal and External Eye Diseases

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Operacija katarakte kod bolesnika sa obostranim nekrotizujućim skleritisom i perifernim ulceroznim keratitisom u sklopu granulomatoze sa poliangiitisom (Wegener-ova granulomatoza)

Sažetak

Biografije autora

Reference