角膜胶原交联术后无菌性角膜炎的临床特征及治疗转归  

Clinical features and treatment outcome of sterile keratitis after corneal collagen cross-linking

作　　者：顾宇伟 庞辰久[1] 任胜卫 杨凯丽 范棋 徐丽妍 张波[1] 王树林 李金[1] GU Yuwei;PANG Chenjiu;REN Shengwei;YANG Kaili;FAN Qi;XU Liyan;ZHANG Bo;WANG Shulin;LI Jin(Henan Provincial People’s Hospital,Henan Eye Hospital&Henan Eye Institute,Zhengzhou 450003,Henan Province,China)

机构地区：[1]河南省人民医院河南省立眼科医院&河南省眼科研究所,河南省郑州市450003

出　　处：《眼科新进展》2023年第10期804-808,共5页Recent Advances in Ophthalmology

摘　　要：目的探讨圆锥角膜患者进行角膜胶原交联(CXL)术后无菌性角膜炎的临床特点、治疗及愈后。方法回顾性系列病例研究。选择2018年1月至2020年9月河南省立眼科医院屈光手术中心281例(387眼)圆锥角膜患者,其中行CXL术后发生无菌性角膜炎的患者为炎症组(9例11眼),选取同期CXL术后无并发症的圆锥角膜患者为对照组(23例30眼),比较炎症组与对照组患者的年龄、性别、平坦角膜曲率(K_(1))、陡峭角膜曲率(K_(2))、散光(Astig)及最薄点角膜厚度(TCT)的差异。采用多因素Logistic回归分析无菌性角膜炎发生的影响因素。结果CXL术后发生无菌性角膜炎患者9例11眼,发生率为2.84%,均发生在去上皮CXL术后。9例11眼均于术后1周内出现无菌性角膜炎,1眼同时累及角膜中央区、旁中央区及周边部,1眼累及旁中央区,其余9眼均位于角膜周边部。炎症组与对照组患者的年龄、性别、K_(1)、K_(2)、Astig及TCT差异均无统计学意义(均为P>0.05)。经皮质类固醇激素治疗,预防性使用抗生素滴眼可以取得良好效果。Logistic回归分析结果显示,年龄、性别、K_(1)、K_(2)、Astig及TCT均不是无菌性角膜炎发生的危险因素(均为P>0.05)。结论圆锥角膜患者行CXL后无菌性角膜炎常见于去上皮CXL患者中,一般发生在术后早期,病灶多在角膜周边部,以皮质类固醇激素为主的治疗可以取得良好效果。Objective To investigate the clinical features,treatment and prognosis of sterile keratitis after corneal collagen cross-linking(CXL)in patients with keratoconus.Methods A total of 387 eyes from 281 keratoconus patients who received the CXL surgery at the Refractive Surgery Center of Henan Eye Hospital from January 2018 to September 2020 were enrolled in this retrospective case series study.The patients with sterile keratitis after the CXL surgery were included in the inflammation group(9 patients and 11 eyes).Keratoconus patients without complications after the CXL surgery during the same period were selected in the control group(23 patients and 30 eyes).The age,gender,flat keratometry(K_(1)),steep keratometry(K_(2)),astigmatism(Astig)and the thinnest corneal thickness(TCT)were compared between the inflammation group and the control group.Multivariate logistic regression was used to analyze the factors inducing the sterile keratitis.Results After the CXL surgery,9 patients(11 eyes)developed sterile keratitis in one week,accounting for 2.84%of the recruited patients.All these 9 patients underwent epi-off CXL surgery.Among the 11 eyes,the sterile keratitis involved the central,paracentral and peripheral cornea simultaneously in one eye,involved the paracentral cornea only in one eye,and involved the peripheral cornea only in the rest 9 eyes.No significant differences were found in age,gender,K_(1),K_(2),Astig and TCT between the inflammation group and the control group(all P>0.05).The corticosteroid therapy and preventive use of antibiotic eyedrops achieved good effects.Logistic regression analysis results showed that age,gender,K_(1),K_(2),Astig and TCT were not significantly associated with the occurrence of sterile keratitis(all P>0.05).Conclusion The post-CXL sterile keratitis in keratoconus patients generally occurs in the early stage after epi-off CXL surgery,and it mostly concentrates in the peripheral part of the cornea.Corticosteroid-related therapy can obtain good effects.

关 键 词：角膜胶原交联 去上皮 无菌性角膜炎 圆锥角膜 

分 类 号：R772.2[医药卫生—眼科]