共聚焦显微镜对真菌性角膜炎板层角膜切除联合羊膜移植临床观察  

Observation of the effects that fungal keratitis treated by corneal lamellar resection combined with amniotic membrane （AM） transplantation using confocal microscopy

作　　者：裴森[1] 姬亚州 吴爱红[1] 申蕾[1] 穆泽辰[1] 

机构地区：[1]安阳市眼科医院,河南455000

出　　处：《中国实用眼科杂志》2014年第9期1097-1100,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的应用共聚焦显微镜判断真菌性角膜炎行板层角膜切除联合羊膜移植治疗后的转归。方法对2010年1月至2011年6月在安阳市眼科医院门诊经共聚焦显微镜确诊为真菌性角膜炎患者30例30只眼，于角膜病灶未累积内皮层、给予抗真菌药物治疗1周后，行板层角膜病灶切除联合羊膜移植术。并分别在治疗前及治疗后7、14、21、28d和3、6个月，应用共聚焦显微镜对患者角膜病灶的特定位点进行检查，观察视力变化、局部菌丝的有无、菌丝的密度、炎症细胞密度和形态的变化，以及感染区角膜基质细胞的变化；对手术治疗进行评估，同时为判断抗真菌药物的疗效提供依据，以此调整药物用量。对共聚焦显微镜未见真菌菌丝及炎症细胞的患者在巩固治疗1周后逐渐停药。结果治疗前视力≤0.05者21只眼，0.05～0.2者9只眼。治愈后（治疗21 d）视力≤0.05者3只眼，0.05～0.2者24只眼，≥0.2者3只眼，治疗前后视力变化比较差异有统计学意义（Zc=4.2007，P〈0.01）。结论共聚焦显微镜检查是目前判断真菌性角膜炎药物治疗疗效理想手段，并能为临床调整用药提供客观依据。Objective To observe the effects that fungal keratitis treated by corneal lamellar resection combined with amniotic membrane transplantation using confocal microscopy. Methods Thirty patients （30 eyes）, treated from January 2010 to June 2011, whose cornea lesion didn＇t involve the endothelial layer of cornea and diagnosed as fungal keratitis by confocal microscopy, were admitted into our study. All the patients received corneal lamellar resection combined with amniotic membrane transplantation after using antifungal medicine for one week. Confocal microscopy was used to observe the particular lesion of each eye, respectively, before and 7, 14, 21, and 28 days, 3 and 6 month after the treatment. The changes of visual acuity were observed. Results Before treatment, visual acuity of 21 eyes was≤0.05, 9 in 0.05-0.2. The final visual acuity was that 3 eyes were ≤ 0.05, 24 in 0.05 to 0.2, and 3≥0.2. The difference of decreasing visual acuity was statistically significant （Zc=4.2007, P≤0.001）. Conclusions Confocal microscopy is a fine choice to assess the effect of medicine treatment for fungal keratitis, and can provide an objective evidence for choosing medication in clinic.

关 键 词：真菌性角膜炎 共聚焦激光显微镜 板层角膜切除 羊膜移植 

分 类 号：R743.31[医药卫生—神经病学与精神病学]