角膜移植术后复发性真菌性角膜炎的治疗及疗效分析  

Treatment and prognosis of recurrent fungal keratitis after corneal transplantation

作　　者：赵倩[1] 王婷 史伟云 李素霞 

机构地区：[1]潍坊医学院,261061 [2]山东省眼科医院,济南250021

出　　处：《中华实验眼科杂志》2015年第4期338-341,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金青年基金项目（81200726）;山东省科技发展计划项目（2013GGC03015）;青岛市科技计划项目（13-1-4-240-jch）

摘　　要：背景 真菌性角膜炎患者行角膜移植术后真菌感染复发是导致手术失败的重要原因,临床上因患者复发部位的不同和复发特征的多样化,在选择合适的治疗方法时仍存在困难.目的 探讨真菌性角膜炎患者角膜移植术后真菌感染复发的特征、治疗及转归,为临床诊断和治疗提供参考.方法 采用系列病例回顾性研究设计.收集2004年1月至2011年12月在山东省眼科医院因真菌性角膜炎行角膜移植术的628例患者的临床资料,对其中41例复发性真菌性角膜炎的炎症部位和治疗方案进行分析.结果 复发性真菌性角膜炎的复发部位包括植床感染复发、前房炎症和玻璃体腔炎症;穿透角膜移植术（PKP）术后复发者28例,占7.12％,板层角膜移植术（LKP）术后复发者13例,占5.53％,二者间差异无统计学意义（x2=0.61,P＞0.05）.复发性病变的总体治愈率为87.80％（36/41）.边缘植床复发者11例,包括单纯药物治愈者3例,经手术治愈者8例,其中直径≤2 mm的复发灶经病灶切除术和/或结膜瓣遮盖术治愈6例,而直径＞2 mm的复发病灶则再次行PKP治愈.LKP后植片下植床复发4例,均再次行PKP.前房复发者5例,前房注药后治愈2例,行前房灌洗者2例,再次行PKP者1例.混合复发型12例,即植片、植床、前房均可见炎症复发,通过结膜下或前房注射氟康唑、局部病灶切除或结膜瓣遮盖治愈5例,再次行PKP者7例.眼后段复发者9例,仅4例治愈,5例因治疗无效行眼内容摘除术.结论 真菌的复发特征是选择合适治疗方式的依据,植床复发者首选药物治疗,若药物治疗后3～5d效果较差,则选择再次手术治疗;前房复发者则首选前房内药物注射;眼后段复发应采取玻璃体腔药物注射联合玻璃体切割术.眼前节炎症复发者易治愈,眼后段炎症预后较差.Background Recurrent fungal keratitis after corneal transplantation is a primarily cause of treatment failure.Owing to different recurrence positions and clinical features,to choose the appropriate therapy is relative difficult.Objective This study was to investigate the clinical features,therapy and treating outcome of recurrent fungal keratitis after corneal transplantation.Methods Forty-one patients with recurrent fungal keratitis from 628 patients with fungal keratitis who underwent corneal transplantation at the Shandong Eye Hospital from January 2004 through December 2011 were retrospectively reviewed.The positions of recurrent lesions,managements and outcomes were analyzed.Results The positions of recurrent keratitis included transplantation bed,anterior chamber and vitreous in the 41 patients.The fungal infection relapsed in 28 patients （7.12％） undergone penetrating keratoplasty （PKP） and 13 patients （5.53％） undergone lamellar keratoplasty （LKP）,without significant difference between them （x2 =0.61,P＞0.05）.Thirty-six patients were cured,with the overall cure rate 87.80％.Among the 11 recurrence cases on the edge of recipient bed,3 patients were cured by drug therapy,and other 8 patients were cured by surgery,including lesion resection and/or conjunctival flap cover for 6 patients with lesion ＞2 mm and secondary PKP for 2 patients with lesion ≤ 2 mm.Four patients with recurrence lesion under the graft following LKP were treated by the reoperation PKP.The different managements were performed in 5 recurrent patients in anterior chamber,including intrachamber injection of drug for 2 patients,anterior chamber lavage for 2 patients and PKP again in 1 patient.Multiple-site recurrent lesions were seen in 12 patients,and the lesions were cured by drug therapy,lesion resection or conjunctival flap cover in 5 patients and by PKP again in 7 patients.In 9 patients with vitreous recurrence,only 4 patients were cured by anti-fungal drug,and ocular evisceration were performed in other 5 pat

关 键 词：角膜 感染/复发 治疗 真菌 角膜移植 回顾性研究 

分 类 号：R779.65[医药卫生—眼科]