单纯疱疹性角膜基质炎诊疗中的失误和对策  

Faults and countermeasures in diagnosis of and treatment of herpetic stromal keratitis

作　　者：朱志忠[1] 王印其[2] 张月琴[2] 李季华[2] 靳伟民[2] 邱培瑾[1] 席晓勍[1] 杜诚[3] 

机构地区：[1]中国上海复旦大学附属中山医院眼科,200032 [2]中国河南省眼科研究所,450044 [3]中国浙江省嘉兴市中医医院眼科,314001

出　　处：《美中国际眼科杂志》2002年第3期30-33,共4页

摘　　要：目的 研究单纯疱疹性角膜基质炎(HSK)诊疗中的失误和对策。方法 以含微量地塞米松的复方抗单疱药疱疹灵滴眼剂,≤8.0mm治疗性穿透角膜移植和≥8.5mm深板层角膜移植等三种方法,对87例92眼诊疗失误的HSK作回顾性临床分析。结果 3种治疗方法的治愈率分别为100.0％(39/39),100.0％(3/3)和98.0％(49/50),而复发率(平均随访3年7个月)分别为53.8％(21/39),0.0％(0/3)和2.1％(1/49)。结论 ①HSK临床体征变化的多样性,是导致诊疗失误的主要原因。②单独应用抗单疱药,不符合HSK的发病机理;全身大剂量和/或局部高浓度皮质类固醇,超过了HSK抗炎作用的实际需要,凸显出许多皮质类固醇的不良作用,同样会收到事与愿违的恶果。③含微量地塞米松的复方抗单疱滴眼剂,具有抑毒抗炎双重治疗作用,又避免了大剂量皮质类固醇的不良作用,对HSK疗效卓著,是迄今中外同类药物中的姣姣者。④≥8.5mm的深板层角膜移植术,能够最大限度地清除角膜基质中的病毒抗原,净化潜伏感染基地,是一种对重症HSK安全高效的治疗措施。Objective To investigate the faults and counter-measures in diagnosis of and treatment of herpetic stromal keratitis (HSK). Methods Three treatments: ① anti-herpes eye drops compound containing minimal dosage of dexamethasone; ② ≤8.0 mm of therapeutic penetrating keratoplasty, and ③≥8.5 mm of therapeutic lamellar keratoplasty were respectively given to 87 HSK cases (92 eyes) and the faults and eountermeasures during treatment were analyzed retrospectively. Results The cure rate of the 3 treatments was 100.0%(39/39), 100.0%(3/3) and 98.0%(49/50) respectively and the reoccurrence rate was 53.8%(21/39), 0.0%(0/3) and 2.1% (1/49) respectively. Conclusion The variation in clinical manifestations is the major cause of faulty diagnosis. Anti-herpes preparation alone does not agree with HSK mechanism while systemic high-dosage corticosteroid and/or local high-concentration corticosteroid eye drops are not suggested because of their adverse effects. Anti-herpes eye drops containing minimal dosage of dexamethasone is antiviral and anti-inflammatory so it has remarkable effects on HSK. Lamellar keratoplasty ≥8.5 mm deep can eliminate virus to the maximum and clear the latent source in corneal stroma. It is a safe surgery with high cure effect for patients with serious HSK.

关 键 词：单纯疱疹性角膜基质炎 失误 对策 诊断 治疗 复方抗单疮药疱疹灵滴眼剂 

分 类 号：R772.2[医药卫生—眼科]