前节OCT辅助准分子激光治疗性角膜切削术治疗真菌性角膜溃疡  

Anterior segment optical coherence tomography assisted excimer laser phototherapeutic keratectomy for fungal corneal ulcer

作　　者：祁媛媛[1] 张立军[1] 董贺[1] 张蕊[1] 赵丹[1] 崔中华[1] QI Yuan-Yuan ZHANG Li-Jun DONG He ZHANG Rui ZHAO Dan CUI Zhong-Hua

机构地区：[1]大连医科大学附属大连市第三人民医院眼科,辽宁省大连市116031

出　　处：《眼科新进展》2017年第3期263-266,共4页Recent Advances in Ophthalmology

摘　　要：目的评价前节OCT辅助准分子激光治疗性角膜切削术(excimer laser phototherapeutic,PTK)治疗真菌性角膜溃疡的临床效果。方法回顾性分析已确诊为真菌性角膜溃疡且应用局部和全身抗真菌药物治疗7d后无效或病情加重的24例(24眼)患者,角膜溃疡深度均未超过1/3角膜厚度,将患者分为两组,治疗组接受前节OCT辅助的PTK治疗,共14例(14眼),对照组采用角膜病灶板层切除手术治疗,共10例(10眼)。随访至少6个月。记录治疗前后最佳矫正视力(best corrected visual acuity,BCVA)、角膜厚度、共焦显微镜检查情况。观察术后角膜上皮修复时间、治疗时间及并发症情况。结果两组术后BCVA均较术前明显提高,差异均有统计学意义(均为P<0.01),治疗组BCVA提高程度明显优于对照组,差异有统计学意义(P<0.05)。治疗组术后治疗持续时间为(19.43±5.68)d,短于对照组的(34.40±5.38)d,差异有统计学意义(P<0.05)。治疗组术后剩余角膜厚度与对照组相比差异无统计学意义(P>0.05)。共焦显微镜检查亦治疗组术后残余菌丝较对照组明显减少。治疗组术后上皮修复时间为(4.00±1.11)d,短于对照组的(6.20±1.39)d,差异有统计学意义(P<0.05)。随访期内,治疗组术后无一眼复发,对照组术后0.5 a有3眼复发,1眼药物控制有效,另2眼病情加重,进一步行角膜移植手术。结论前节OCT辅助PTK治疗真菌性角膜溃疡可以有效清除病灶、加速上皮愈合,为治疗早期浅层真菌性角膜溃疡提供了一个全新的选择。Objective To assess the treatment outcomes of anterior segment optical coherence tomography（OCT） assisted excimer laser phototherapeutic keratectomy（PTK） for fungal corneal ulcer.Methods Twenty-four patients （24 eyes） suffered from fungal corneal keratitis were collected by a retrospecive chart review with at least 6 months of follow-up data available.All corneal ulcer depth did not exceed 1/3 corneal thickness and were resistant to local and systemic medication therapy for at least 1 week.Patients were divided into 2 groups.14 patients with 14 eyes were taken PTK and 10 patients with 10 eyes were treated with lamellar keratectomy.Follow-up time was at least 6 months.Visual acuities,corneal thickness,confocal microscope,healing of the epithelial defect and inflammation and complications were recorded.Results The postoperative visual acuity in two groups were significantly improved,visual acuity of PTK treatment group improved significantly better than the control group（P〈0.05）.Healing time of PTK treatment group （19.43±5.68） days was shorter than that of the control group （34.40±5.38） days,the difference was statistically significant （P〈0.05）.There was no significant difference in the residual central corneal thickness between the PTK treatment group and the control group （P〉0.05）.Residual mycelium after operation in the treatment group was significantly decreased than that of control group.Healing time of epithelial in PTK treatment group （4.0±1.1） days was shorter than that of the control group （6.20±1.39） days,the difference was statistically significant （P〈0.05）.There was no corneal dilation in two groups.No recurrence in PTK treatment group was occurred.3 cases in control group had recurrence after 6 months,drug control was effective in 1 case,and other 2 cases undertook corneal transplantation.Conclusion Anterior segment OCT assisted PTK for corneal ulcer can effectively clear the lesion,accelerate epithelial healing,provide a new choice for the treatm

关 键 词：准分子激光治疗性角膜切削术 前节OCT 角膜病灶板层切除 真菌性角膜溃疡 临床观察 

分 类 号：R772.2[医药卫生—眼科]