真菌性角膜炎角膜移植术后真菌感染的临床特征及预后  

Correlation Between Clinical Characteristics of Fungal Infection After Transplantation for Fungal Keratitis and Clinical Outcome

作　　者：李晶[1] 贺燚[1] 柳晓辉 LI Jing;HE Yi;LIU Xiaohui(Department of Ophathomology,Henan Provincial People’s Hospital,Henan Eye Hospital,Henan Eye Institute,Zhengzhou 450003,China)

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

出　　处：《河南医学研究》2024年第14期2551-2554,共4页Henan Medical Research

摘　　要：目的总结真菌性角膜炎手术治疗后真菌感染的临床特征,分析临床表现与预后的关系。方法对河南省立眼科医院2009年1月至2019年12月收治的真菌性角膜炎行角膜手术治疗后真菌感染患者的临床诊治资料进行回顾性分析。结果共12例(12眼),其中男9例,女3例,年龄30~77岁,平均54.83岁。12例患者中8例(66.7%)行眼内容摘除术,4例(33.3%)患者行穿透性角膜移植术,随访12~75个月,3例无复发,1例失访。临床表现中度至重度混合充血,其中角膜移植片水肿混浊5例,角膜全层水肿混浊3例,植床混浊2例,结膜瓣血供丰富,无明显溃疡2例;3例角膜见新生血管长入。12例患者的角膜过碘酸-雪夫染色(PAS)和六胺银染色(GMS)染色中均可见到真菌菌丝结构,其中4例患者苏木精-伊红染色(HE)可见真菌菌丝结构。8例行眼内容摘除患者的角膜基质层纤维均呈化脓性炎症的病理改变,基质层纤维坏死,大量中性粒细胞浸润,其中3例角膜植床和植片组织中可见大量真菌菌丝结构,1例真菌位于角膜植床基质深层,达后弹力层,4例患者无法识别植床和植片结构,基质层纤维可见真菌菌丝结构。结论真菌性角膜炎患者行治疗性角膜手术,可以赢得治疗时间,角膜植床中是否存在真菌菌丝以及菌丝的多少是真菌性角膜炎治疗成败的重要因素,应给予重视,改善患者的预后。Objective To study the clinical characteristics of fungal infection after surgical treatment of fungal keratitis and analyze the relationship between the clinical characteristics and prognosis.Methods In this retrospective study,the clinical data and features of fungal infection patients after corneal surgery for fungal keratitis in Henan Eye Hospital from January 2009 to December 2019 were collected and analyzed.Results There were 12 cases(12 eyes),including 9 males and 3 females.Mean age was 54.83 years old(30 to 77 years old).Of the 12 patients,8 cases(66.7%)underwent evisceration of the eye,4 patients(33.3%)underwent penetrating corneal transplantation,3 cases had no recurrence and one case was lost in the follow-up of 12 to 75 months.All patients were moderate or serious conjunctival congestion,5 cases showed corneal graft edema and opacity,3 cases were corneal edema and opacity,2 cases were corneal bed opacity and 2 cases were abundant blood supply of conjunctiva flap without ulcer.In 3 cases,corneal neovascularization were found.Periodic acid-Schiff staining(PAS)and Gomori’s methenamine silver staining(GMS)can find fungi in all patients,haematoxylin-eosin staining(HE)also find fungi in 4 patients.Eight patients who were failure after therapeutic keratoplasty showed corneal stroma purulent inflammation,whose corneal fibers were necrosis and were infiltrated by neutrophils.Fungal hyphae were found in corneal graft and bed in three cases.In one case,fungus was located in the deep layer of corneal bed.The graft and bed structure were not identified in 4 cases,and fungus was found in the cornea.Conclusion Though corneal surgery could give a broadened therapeutic window for fungal keratitis patients,the important factors of prognosis of the treatment are the presence of fungal hyphae and the amount of the hyphae in the graft.It should be paid more attention to improve the prognosis of the disease.

关 键 词：真菌 角膜炎 角膜移植术 临床特征 预后 

分 类 号：R779.65[医药卫生—眼科]