角膜溃疡清创联合羊膜覆盖术及药物治疗真菌性角膜炎的临床疗效  

Clinical efficacy of the combination of lesion debridement with amniotic membrane cover and drugs for fungal keratitis

作　　者：李青[1] 赵桂秋[1] 林静[1] 王谦[1] 郭彦丽[1] 刘莹[1] 

机构地区：[1]青岛大学附属医院眼科,266003

出　　处：《中华实验眼科杂志》2014年第9期824-828,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 真菌性角膜炎发病率高,临床上因缺乏高效、低毒和广谱的抗真菌药物,治疗较为棘手.穿透角膜移植是目前有效的治疗方法,但角膜供体缺乏限制了该手术的开展.寻求经济、有效的治疗方法具有重要临床意义. 目的 比较角膜溃疡清创联合羊膜覆盖术及药物治疗与角膜溃疡清创联合药物治疗对真菌性角膜炎的临床治疗效果.方法 采用前瞻性病例对照研究方法,收集2001年1月至2013年1月在青岛大学附属医院确诊为真菌性角膜炎的患者210例210眼,随机数字表法分为观察组109例和对照组1 01例,2个组患者基线特征匹配.观察组患者采用角膜溃疡清创联合羊膜覆盖术及药物治疗法,对照组应用角膜溃疡清创联合药物治疗法,对2个组间患者的治疗效果、平均视力和平均疗程进行比较. 结果 观察组轻、中、重度真菌性角膜炎患者的有效率分别为100.00％、90.41％、77.78％;对照组分别为52.38％、80.00％、25.00％,差异均有统计学意义（U=2.211、2.214、2.356,P＜0.05）;观察组治疗总有效率为91.09％,对照组为75.23％,差异有统计学意义（U=3.040,P=0.002）.观察组治疗的平均视力为0.44±0.04,明显好于对照组的0.22±0.03,差异有统计学意义（t=2.225,P＜0.05）;观察组治疗疗程平均为（22.4±1.8）d,明显短于对照组的（33.2±2.4）d,差异有统计学意义（t=2.097,P＜0.05）.结论 角膜溃疡清创联合羊膜覆盖术和药物治疗是治疗真菌性角膜溃疡的有效方法,有助于缩短疗程,提高治疗效率,明显优于角膜溃疡清创联合药物治疗法.Background Fungal keratitis is a common ocular surface disease and the treatment is dissatisfactory because of short of high efficiency,low toxicity and broad-spectrum medication.Penetrating keratoplasty is an effective therapy,but its clinical applications is limited due to lack of corneal donor.To seek a low-cost and effective management is of an important significance.Objective This clinical trial was to compare the clinical effectiveness between corneal ulcer debridement combined with amniotic membrane cover＋drugs therapy and corneal ulcer debridement of combined drugs therapy for fungal keratitis.Methods A prospective cases-controlled study was designed.A total 210 eyes of 210 patients with fungal keratitis were included from January 2001 to January 2013 in Affiliated Hospital of Qingdao University.The patients were randomly divided into observation group （109 eyes） and control group （101 eyes）.The combination therapy of corneal ulcer debridement with amniotic membrane cover and drugs was administered in the observational group,and only lesion debridement and drugs therapy was performed on the control group.The curative effect,postoperative visual acuity and therapeutic course were compared between the two groups.Results The effective rates for fungal keratitis were 100.00%,90.41%,77.78% in the mild,moderate and severe patients,respectively,and those of the control group were 52.38%,80.00%,25.00% respectively,showing significant differences between them （U =2.211,2.214,2.356,all at P〈0.05）.The total effective rate was significantly higher in the observational group than that in the control group （91.09% versus 75.23%）,with a significant difference between them （U=3.040,P=0.002）.Postoperative visual acuity was better in the observational group than that in the control group （0.44 ± 0.04 versus 0.22 ± 0.03）,with a significant difference between them （t =2.225,P 〈 0.05）.The mean therapeutic course was （22.4 ± 1.8） days in the observational group,which is shorter than （

关 键 词：真菌 感染 角膜炎 手术 治疗 羊膜 

分 类 号：R772.21[医药卫生—眼科]