穿透角膜移植术治疗不同病原菌引起的严重感染性角膜溃疡的疗效比较及分析  

Comparation and analysis of therapeutic effect of penetrating keratoplasty for severe infectious keratitis caused by different pathogens

作　　者：彭旭东[1] 赵桂秋[1] 李坚恩[1] 林静[1] 胡丽婷[1] 姜楠[1] 王谦[1] 曲建秋 王晓川[1] 

机构地区：[1]青岛大学附属医院眼科,266000

出　　处：《中华实验眼科杂志》2016年第2期150-154,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目（81170825、81470609）;2012年度高等学校博士学科点专项科研基金资助课题（20123706110003）;山东省自然科学基金青年项目（ZR2013HQ007）;山东省自然科学基金重点项目（ZR2012FZ001）

摘　　要：背景感染性角膜炎是角膜病致盲的主要原因之一。对于药物治疗无效的严重感染性角膜溃疡患者若面临角膜穿孔甚至丧失眼球的危险时应首先考虑行穿透性角膜移植术（PKP）。目前尚缺乏比较PKP治疗不同病原菌导致引起的严重感染性角膜溃疡患者疗效的研究。目的探讨不同病原菌引起的严重感染性角膜溃疡行PKP后的临床效果。方法采用回顾性研究设计，对2008年1月至2014年1月于青岛大学附属医院确诊为严重感染性角膜溃疡且行PKP的患者210例221眼的临床资料进行分析，按照感染病原菌的种类将患眼分为真菌性角膜溃疡组（155眼）、细菌性角膜溃疡组（30眼）、病毒性角膜溃疡组（28眼）和棘阿米巴性角膜溃疡组（8眼），各组术眼术前不同等级视力的眼数分布相匹配。术后随访6～24个月，比较各组手术治疗的有效率、不同等级视力的眼数分布、角膜排斥反应发生率和病变复发率的差异。结果本组分析的病例中，真菌性角膜溃疡者居首位，为70．1％（155／221），细菌性角膜溃疡占13．6％（30／221），病毒性角膜溃疡占12．7％（28／221），棘阿米巴性角膜溃疡占3．6％（8／221）。真菌性角膜溃疡组、细菌性角膜溃疡组、病毒性角膜溃疡组和棘阿米巴性角膜溃疡组行PKP的有效率分别为88．5％、86，7％、92．8％和75．0％，各组问差异无统计学意义（X2=4．022，P=0．259）。细菌性角膜溃疡组和病毒性角膜溃疡组术后最佳矫正视力（BCVA）均明显好于真菌性角膜溃疡组，差异均有统计学意义（Z=-5．125、-7．504，均P〈0．001），病毒性角膜溃疡组术后BCVA明显优于细菌性角膜溃疡组，差异有统计学意义（Z=-3．189，P=0．001）。随访中170眼患者角膜植片透明，有26眼角膜植片发生混浊和新生血管化，另有25眼植片周边部有少量新生血管长入，各组角膜植片不Background Refractory infectious keratitis is one of the leading causes of corneal blindness. Penetrating keratoplasty （PKP） is a primary approach to serious infectious keratitis patients who did not feasible to drug therapy. However, the comparative study on PKP outcomes of different pathogens-caused severe infectious keratitis is still lack at present. Objective This study was to evaluate the therapeutic effect of PKP on severe keratitis infected by fungus,bacteria,virus and acanthamoeba. Methods The clinical data of a total of 221 eyes of 210 patients who underwent PKP from severe infectious keratitis at Affiliated Hospital of Qingdao University from January,2008 to January, 2014 were retrospectively analyzed and reviewed. The patients were grouped to fungal infected group （155 eyes）, bacterial infected group （30 eyes）, virus infected group （28 eyes） and acanthamoeba infected group （8 eyes）. The follow-up duration was 6-24 months. The effective rate of treatment, eyes in different graded visual acuities, rejected rate and recurrence rate were compared among different groups. Results The percentage of fungal keratitis was 70. 1% （155/221） ,and that of bacterial keratitis,virus keratitis and acanthamoeba keratitis was 13.6% （30/221） ,12.7% （28/221） and 3.6% （8/221） ,respectively. The effective rates of PKP were 88.5% ,86. 7% ,92.8% and 75.0% in the fungal infected group, bacterial infected group,virus infected group and acanthamoeba infected group, respectively, showing insignificant difference among the groups （X2 = 4. 022, P = 0. 259）. The postoperative best corrected visual acuity （BCVA） was better in the bacterial infected group than that in the fungal infected group or virus infected group （ Z = -5. 125, -7. 504, both at P〈0. 001 ） , and the postoperative BCVA in the virus infected group was superior to bacterial infected group （Z =-3. 189 ,P = 0. 001 ）. The grafts were clear in 170 post-PKP eyes,and corneal opacity and neovascularization were observed i

关 键 词：角膜溃疡 感染 穿透角膜移植 疗效 

分 类 号：R779.65[医药卫生—眼科]