药物源性角膜病变临床特征和治疗回顾分析  

Retrospective analysis of clinical features and management for drug-induced keratopathy

作　　者：刘艳红 王婷[2] 史伟云[2] 李素霞[2] 

机构地区：[1]解放军第四五六医院眼科 [2]山东省医学科学院山东省眼科研究所,济南250021

出　　处：《中华实验眼科杂志》2014年第3期246-250,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金青年基金项目（81200726）;山东省自然科学基金青年基金项目（ZR2010HQ011）;泰山岗位项目资助（ts20081148）

摘　　要：背景 近年来药物源性角膜病变患者日益增多.临床特征不典型,诊断困难,常与原发病混淆,容易误诊,病情迁延不愈,严重影响视力,总结药物源性角膜病变的临床特征及规范治疗方法是亟需解决的问题. 目的 探讨药物源性角膜病变临床特征及治疗转归.方法 采用回顾性系列病例观察分析方法.收集2008年5月至2012年10月就诊于山东省眼科医院的药物源性角膜病变患者31例36眼,详细记录其既往眼病史、用药史、用药持续时间及给药途径,检查患眼治疗前及治疗后2周和1个月的最佳矫正视力（BCVA）、基础泪液分泌试验Ⅰ（SⅠt）、泪膜破裂时间（BUT）；裂隙灯显微镜下观察患眼睑板腺情况、角膜病变的位置及角膜荧光素钠染色情况.治疗均首先停用原有药物,给予促进角膜修复药物及少量抗炎药物的方案,合并睑板腺功能障碍者行热敷及睑板腺按摩,S Ⅰ t＜5 mm/5 min和BUT＜5s者行泪小点栓塞治疗.采用SPSS 17.0统计学软件进行分析,对治疗前及治疗后1周患眼BCVA的差异行配对t检验；对手术前后3个时间点患眼的BUT和SⅠt结果的差异行重复测量单因素方差分析；对患眼角膜修复天数与SⅠt的关系行Pearson积矩直线相关分析. 结果 导致角膜病变的主要原因为不合理用药,其中抗病毒药物不合理应用者23例,抗生素药物16例,糖皮质激素药物10例,抗过敏药物1例,降眼压药物1例.不合理给药途径包括局部频繁点眼25例及连续球结膜下注射6例.患眼治疗后1个月的BCVA为0.69 ±0.28,明显优于治疗前的0.32±0.26,差异有统计学意义（t=11.02,P＜0.01）.药物源性角膜病变主要表现为角膜上皮弥漫性细点状粗糙,严重者合并角膜上皮缺损,甚至角膜溃疡,角膜伴有不同程度的水肿,局部出现后弹力层皱褶,部分可见角膜丝状物附着,病变区主要位于角膜中央及下方.药物源性角膜病变的治疗主要是停用原有Background In recent years,incidence of drug-induced keratopathy is increasing highly.Druginduced keratopathy is lack of typical clinical features and offen confused with the primary disease.Therefore,summarizing and concluding the clinicals feature and standard treatments of drug-induced keratopathy are key problem need to be solved urgently for us.Objective This study was to retrospectively analyze the clinical features and therapeutic procedure of drug-induced keratopathy.Methods A retrospective case series analysis method was adopted.The clinical data of 36 eyes （31 patients） with drug-induced keratopathy were collected by Shandong Eye Hospital from 2008 to 2012,including eye disease history,medication history,medication dosage and duration.A series of relevant examinations were performed,including best corrected visual acuity （BCVA） before and 1 month after treatment,Schirmer test Ⅰ （S Ⅰ t）,tear film break-up time （BUT）,meibomian gland findings,the location of the keratopathy,the characteristics of keratophthy before and after fluorescein staining.The treating were given,including cessating of the original drugs,applying corneal repair promotion and anti-inflammatory drugs as well as the comprehensive treatment for meibomian gland embolization and dry eye,such as the hot packs and massage in the eyes with meibomian gland dysfunction and a tear dot embolization therapy in the eyes with S Ⅰ t ＜ 5 mm and BUT＜5 s.Paired t test and repeated measured one-way analysis of variance in SPSS 17.0 software were used to compare the BCVA,BUT and S Ⅰ t outcomes.The correlation between corneal repair duration and S Ⅰ t results was analyzed by Pearson linear correlation analysis.Results The primary cause of drug-induced keratopathy was irrational use of drugs,including antiviral drugs,antibiotics,hormone,antiallergic,lowering-intraocular pressure drugs,turn for 23 eyes,12 eyes,10 eyes,1 eye and 1 eye,respectively.Improper route of administration included 25 cases of overuse of eye drops and 6 ca

关 键 词：药物相关性不良反应 角膜病变 化学诱导 角膜上皮 病变 角膜内皮 病变 眼表 疾病 视力 

分 类 号：R772.2[医药卫生—眼科]