穿透性角膜移植治疗棘阿米巴角膜炎的临床研究  

Clinical study of the treatment of acanthamoeba keratitis by penetrating keratoplasty

作　　者：史伟云[1] 高华[1] 李绍伟[1] 王富华[1] 谢立信[1] 

机构地区：[1]山东省眼科研究所暨眼科医院,青岛266071

出　　处：《中华眼科杂志》2004年第11期750-754,共5页Chinese Journal of Ophthalmology

摘　　要：目的　探讨术前诊断和围手术期药物治疗等因素对穿透性角膜移植治疗严重棘阿米巴角膜炎术后复发的影响。方法　对 1996～ 2 0 0 2年诊治的 18例棘阿米巴角膜炎患者进行临床分析 ,术前确诊 12例 ,误诊 6例 ,角膜感染直径均大于 7mm。治疗过程中 18例患者均因病情加重而行穿透性角膜移植术 (PKP)。术后依据术前诊断 ,确诊者继续给予抗阿米巴药物治疗 ,而误诊者继续术前的抗病毒、真菌及细菌治疗。 7例患者 (确诊 2例 ,误诊为病毒性角膜炎 3例 ,细菌性角膜炎 2例 )在术后早期接受全身和局部的糖皮质类激素药物治疗。对诊断的准确性和术后早期持续使用 (>7d)糖皮质激素两个因素与术后复发情况进行病例 对照研究 ,计算其比数比。结果　随访时间平均 10个月 ,13例 (72 % )患者未见复发 ,其中术前确诊 11例 ,误诊 2例 ;5例 (2 8% )患者术后复发。 7例患者术后接受了持续糖皮质激素治疗 ,其中 4例复发。计算误诊和术后早期持续使用糖皮质激素两种影响因素对复发的影响的比数比分别为 2 2 (P =0 0 2 1)和 13(P =0 0 4 7)。结论　PKP是治疗药物不能控制的严重棘阿米巴角膜炎的有效方法。术前明确诊断、围手术期抗阿米巴治疗及早期避免持续使用糖皮质激素可降低棘阿米巴角膜炎术后的复发率。 (中华眼科杂志 ,2Objective To evaluate the influence of accurate diagnosis and peri-operative management on the recurrence of acanthamoeba keratitis after penetrating keratoplasty.Methods A retrospective study of 18 cases of medically unresponsive keratitis in Shandong Eye Institute and Hospital that were confirmed as acanthamoeba keratitis based on laboratory examination or histopathological studies. The diagnosis of acanthamoeba keratitis was made prior to the surgery in 12 cases and delayed until histopathological results in six cases. All cases ran a course of one to four months prior to penetrating keratoplasty with lesions measuring larger than 7 mm at the time of surgery. Corresponding anti-microbial agents were given pre-operatively based on the suspected etiological agents. Corticosteroids were given to two eyes diagnosed as acanthamoeba keratitis, three eyes misdiagnosed as herpes simplex keratits and two eyes misdiagnosed as bacterial keratitis. Results In 13 cases without recurrence (72%), 11 cases were correctly diagnosed as acanthamoeba keratitis prior to the surgery. In five cases with relapse (28%), four cases were misdiagnosised prior to the surgery. Seven cases received corticosteroid therapy more than one week in early post-operative period and four cases developed recurrence. In the four cases with relapse, two were misdiagnosed as herpes keratitis and two were misdiagnosed as bacterial keratitis. The odds ratis of the effect of two factors (misdiagnosis and using of corticosteroid in early post-operative period) on the rate of recurrence were 22 (P=0.021) and 13 (P=0.047), respectively.Conclusions Penetrating keratoplasty is an effective treatment for medically unresponsive acanthamoeba keratitis. Accurate pre-operative diagnosis, appropriate peri-operative amoebicidal therapy and avoidance from the use of corticosteroid in the early post-operative period can decrease the incidence of recurrence of acanthamoeba keratitis after penetrating keratoplasty.

关 键 词：治疗 棘阿米巴角膜炎 患者 术前 糖皮质激素 确诊 误诊 比分 和局 结论 

分 类 号：R779.65[医药卫生—眼科]