角膜伤口缝合术后迟发性角膜溃疡的临床分析  

Clinical analysis of delayed corneal ulcer after corneal wound suture surgery

作　　者：胡艳滨[1] 马林[2] 

机构地区：[1]天津市第三中心医院分院眼科,300250 [2]天津市眼科医院眼表角膜病科,300020

出　　处：《中华眼外伤职业眼病杂志》2016年第1期29-32,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的分析角膜伤口缝合术后患者迟发性角膜溃疡的临床特征及发病原因。方法回顾性分析6例（6眼）角膜伤口缝合术后迟发的角膜溃疡的临床资料，分析患者角膜溃疡的发病特点和临床特征，均行角膜共聚焦显微镜检查、角膜刮片镜检及病原菌培养，并回顾分析既往外伤史、手术史、用药史及细菌真菌培养结果，探讨其迟发角膜溃疡与外伤及手术的相关性，分析角膜溃疡培养病原菌与外伤时培养病原菌是否一致。结果6例中男4例（4眼），女2例（2眼），年龄3—60岁。4例角膜溃疡围绕松动的角膜缝线，3例经历2—3次眼部手术，1例合并睑缘炎，2例曾长期反复应用糖皮质激素滴眼液；6例角膜溃疡细菌培养阳性3例、阴性3例；真菌培养阳性1例、阴性5例。外伤初诊时细菌培养阳性1例、阴性2例、病原菌情况不详3例；对比培养结果显示，除3例因外伤时病原菌不详无法比较外，其余3例感染角膜溃疡的病原菌与外伤时病原菌均不一致。结论对角膜伤口缝合术后患者，应严密随访，及时发现并处理睑缘炎症、角膜缝线松动等并发症；合理眼部用药，控制多次手术节奏，避免由于眼表微环境恶化诱发角膜感染，影响视功能。Objective To analyse the clinical features and etiopathogenesis of delayed corneal ulcer after corneal wound suture surgery. Methods A retrospective case study. Six eyes of six patients with delayed corneal ulcer after receiving corneal wound suture surgery were recruited. The clinical features of corneal ulcer were analysed. Outcomes of corneal eonfocal microscopy, corneal smear microscopy as while as bacteria and fungus culture were analyzed. Past histories of trauma, surgery and medication were also evaluated. Results Four patients were male and 2 patients were female. The age ranged from 3 to 60 years old. In four patients corneal ulcers were around the loosened corneal sutures. Three patients experienced 2 to 3 times of eye surgeries. One patient suffered from blepharifis. Two patients received long time eye dropping with glucocorticoids. Bacterial culture of the corneal ulcers showed positive in 3 cases and negative in 3 cases. Fungal culture showed that one was positive and the other five were negative. In the 6 bacterial culture at the initial traumatic time, one was positive, two were negative and the other three were unknown. For the positive one, the pathogens cultured in corneal ulcer were not the same as that cultured at initial traumatic time. Conclusion Patients who received corneal wound suture surgery should be closely followed up. Blepharitis and loosened sutures should be treated timely. Rational eyedrops using and proper controlling of multiple eye surgeries should be considered. It＇s also important to avoid deteriorating the ocular microenvironment which could induce the infection of cornea.

关 键 词：角膜溃疡 角膜伤口 缝合术后 病原菌 

分 类 号：R779.6[医药卫生—眼科]