LASEK术后单纯疱疹病毒性角膜炎的诊断及治疗  

Diagnosis and treatment of herpetic keratitis after laser-assisted sub-epithelial keratomileusis

作　　者：邸岩[1] 张岩[1] 

机构地区：[1]吉林大学第二医院眼科,吉林省长春市130041

出　　处：《眼科新进展》2011年第10期948-951,共4页Recent Advances in Ophthalmology

基　　金：吉林省科技发展计划项目资助(编号:200705251);吉林省科技发展计划项目资助(编号:20080727)~~

摘　　要：目的探讨准分子激光上皮下角膜磨镶术(laser-assisted sub-epithelial keratectomy,LASEK)术后单纯疱疹病毒性角膜炎(herpes simplex keratitis,HSK)的发病原因、诊断方法及药物联合治疗效果。方法对LASEK术后出现感染性角膜炎,疑为HSK的9例(15眼)患者进行分析。记录所有患者临床表现,采集泪液和角结膜拭子标本,应用病毒分离培养、免疫组化和多重PCR方法进一步明确诊断同时确定感染病毒的种类;之后采用局部加全身联合应用抗病毒药物进行治疗。结果病毒分离培养结果显示15眼中6眼为HSV-1感染,9眼未分离出病毒;免疫组化结果显示10眼病毒感染阳性,其中9眼为HSV-1感染,1眼为VZV感染;多重PCR检测出13眼病毒感染阳性,其中12眼HSV-1感染,1眼VZV感染。因此,多重PCR方法比病毒分离培养和免疫组化方法敏感,病毒阳性检出率高。经抗病毒治疗后,8例(13眼)角膜恢复透明,1例(2眼)发生Ⅰ级和Ⅱ级角膜上皮下混浊(Haze)。结论 LASEK术后角膜病毒感染以HSV-1最常见,伴皮肤疱疹时VZV感染较多。激光切削角膜前弹力层和前基质层,发生疱疹病毒感染时病变形态不典型,应用多重PCR方法诊断,省时省力,阳性率高。联合应用抗病毒药物可加快病变愈合。Objective To investigate the etiology,diagnostic methods and the effect of combining antiviral therapy on herpes simplex keratitis（HSK） after laser-assisted sub-epithelial keratectomy（LASEK）.Methods Clinical manifestations,acquisition tear and conjunctival swab were observed in 9 patients（15 eyes）,which suspected with HSK after LASEK.The infected virus strains were confirmed by three laboratory diagnosis methods,including virus isolation,immunohistochemistry and multiplex PCR.Furthermore,the effect of combining antiviral therapy on herpetic keratitis was testified.Results The virus isolation results showed that 6 in 15 eyes were diagnosed by HSV-1 infection,and not found in other 9 eyes.The Immunohistochemistry showed that 10 in 15 eyes infected virus including 9 eyes with HSV-1 infection and 1 eye with VZV infection.The multiplex PCR results showed that 13 in 15 eyes infected virus.Among those 13 eyes,12 eyes were infected by HSV-1 and 1 eye was infected by VZV.The data indicated that multiplex PCR were more sensitive than virus isolation and immunohistochemistry.After combining antiviral therapy,8 patients（13 eyes） recovered and 1 patient（2 eyes） remained with Ⅰ and Ⅱ Haze.Conclusions HSV-1 is a common virus strain,which infects corneal after LASEK.However,VZV infection happens mostly when patients present with skin herpes.The multiplex PCR is an effective and sensitive method to diagnose herpetic keratitis after LASEK.The combination antiviral therapy is effective to treat herpetic keratitis after LASEK with shorter recovery period.

关 键 词：准分子激光 角膜屈光手术 LASEK 疱疹病毒 角膜炎 

分 类 号：R772.2[医药卫生—眼科]