双眼难治性非感染性角膜炎1例  

A case of bilateral refractory noninfectious keratitis

作　　者：杨依迪 李敏[1] 柯碧莲 YANG Yidi;LI Min;KE Bilian(Department of Ophthalmology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院眼科,上海200127

出　　处：《中国眼耳鼻喉科杂志》2025年第S1期19-24,27,共7页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：37岁男性,因“双眼红痛、视物不清伴畏光流泪7个月余”就诊。既往外院诊断为“双眼病毒性角膜炎”,行抗病毒治疗及角膜上皮修复治疗7个月无好转。查体发现双眼角膜中央部溃疡,角膜知觉减退。角膜共聚焦显微镜检查提示未见角膜上皮下神经丛,未见真菌菌丝以及阿米巴包囊,宏基因高通量测序未检出病原体。最终诊断:双眼神经营养性角膜炎,行双眼角结膜清创及羊膜覆盖手术,同时给予双眼局部角膜营养剂和预防性抗菌素滴眼液治疗,术后患者双眼角膜上皮修复,瘢痕化愈合。讨论体会:对于双眼角膜炎患者,需结合病史和检查全面评估,区分其病因是感染性还是非感染性因素导致。同时,正确解读测序检查结果至关重要,结合患者的全身情况,经多学科协作讨论后得到最终诊断。A 37-year-old male patient presented with“redness,decreased vision with photophobia and tearing in both eyes for more than 7 months”.He had been diagnosed with bilateral viral keratitis previously in another hospital,and had been treated with antiviral therapy and corneal epithelial repair for 7 months without improvement.Examination revealed corneal ulcers in the central part of the cornea of both eyes and corneal hyperalgesia.Corneal confocal microscopy showed that the patient’s corneal subepithelial nerve plexus was not visible,typical mycelium and amoebic encapsulation were not seen,and the pathogen was not detected by metagenomic high-throughput sequencing either.The final diagnosis was bilateral neurotrophic keratitis.Corneal conjunctival debridement and amniotic membrane coverage were performed in both eyes,and topical corneal trophic agents and prophylactic antimicrobial drops were given to both eyes,and the corneal epithelium of both eyes was repaired and healed with scarring after the surgery.Discussion:For patients with bilateral keratitis,it is necessary to comprehensively evaluate the patient with medical history and examination to distinguish whether the etiology is infection or non-infection.At the same time,the correct interpretation of the sequencing test results is crucial,and the final diagnosis should be made after multi-disciplinary discussions,taking into account the patient’s general condition.

关 键 词：角膜炎 非感染性 神经营养性角膜炎 

分 类 号：S85[农业科学—兽医学]