多元化治疗252例真菌性角膜炎的临床分析  

Clinical analysis of multiple therapies for 252 cases of fungal keratitis

作　　者：王璐璐[1] 焦建慈 贺燚[1] 李家臣[1] 赵东卿[1] 

机构地区：[1]河南省眼科研究所河南省立眼科医院,河南省郑州市450003 [2]河南省直第三人民医院,河南省郑州市450003

出　　处：《中国实用眼科杂志》2016年第1期45-49,共5页Chinese Journal of Practical Ophthalmology

基　　金：河南省医学科技攻关计划项目（201403199）

摘　　要：目的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且角膜供体缺乏，治疗较为棘手。寻求经济、有效地治疗方法具有重要临床意义。方法临床病例前瞻性研究。收集2013年1月至2014年1月期间于河南省眼科研究所门诊就诊的真菌性角膜炎患者252例252只眼，先行药物治疗2—3周后，对药物治疗无效者根据病灶范围及深度分别采用病灶切除联合羊膜覆盖术、病灶切除联合结膜瓣覆盖术、板层角膜移植术及穿透角膜移植术治疗，随访至临床治愈后3个月。结果252例患者均为单眼发病，有明确植物外伤史者136例，其他外伤史42例。真菌培养阳性者168例，真菌培养阳性率为66．7％。其中药物治疗痊愈者153例，行病灶切除羊膜覆盖术者12例，病灶切除结膜瓣覆盖术17例，板层角膜移植术15例，真菌感染复发2例，穿透角膜移植20例，真菌感染复发2例。治疗后平均视力较治疗前有一定程度改善，差异有统计学意义（P〈0．05）。临床治疗总有效率为90．25％。所有感染菌种中，曲霉菌角膜炎临床治疗效果不佳（P〈0．05）。结论真菌性角膜炎早期采用多种抗真菌药物联合频繁点眼，可取得较好效果。确诊后应根据病情、病程及现有医疗条件制定多元化治疗方案，提高临床治愈率，改善预后视力。Objective To seek a low-cost and high efficiency treatment medication effectively for fungal keratitis. Methods A prospective study was designed. A total of 252 patients （252 eyes） with fungal keratitis were included from January 2013 to January 2014 in Henan Eye Institute. The medical therapy was initially adopted for first 2 - 3 weeks, and the patients with poor efficacy for drugs were treated by surgery. Depending on the patients＇ different states of illness, corneal ulcer debridement with amniotic membrane cover, corneal ulcer debridement with conjunctival flap cover, lamellar corneal transplantation and penetrating corneal transplantation were performed on the patients. The patients were followed-up for 3 months after clinical cure. Results All patients were monocular fungal keratitis. Among them, 136 patients had the plant injury history, 42 cases had other trauma history and no clear incentives were found in 74 cases. Of those, 168 patients had positive fungal test via corneal scraping examination, Fungal culture positive rate was 66.7%, 153 cases were cured by drug therapy, 12 patients were operated on with corneal ulcer debridement with amniotic membrane cover, 17 patients were operated on with corneal ulcer debridement with conjunctival flap cover. Two patients with recurrent fungal keratitis from 15 patients underwent lamellar corneal transplantation, 2 patients with recurrent fungal keratitis from 20 patients underwent penetrating corneal transplantation. Of 213 patients were cured,with the overall cure rate 90.25%. Of all the pathogenic fungi, Aspergillus had the worst outcome with a low drug cure rate （59.4%） and a higher evisceration rate （Х^2 =6.48, P =0.035）. Conclusions The topical application of multiple drugs is effective for the early stages of fungal keratitis. After the diagnosis, according to the disease and the existing medical conditions to develop a diversified treatment plan, improve the clinical cure rate and the prognosis of visual acuity.

关 键 词：真菌性角膜炎 药物 手术 治疗 

分 类 号：R772.21[医药卫生—眼科]