中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2014年
9期
1097-1100
,共4页
裴森%姬亚州%吴爱红%申蕾%穆泽辰
裴森%姬亞州%吳愛紅%申蕾%穆澤辰
배삼%희아주%오애홍%신뢰%목택신
真菌性角膜炎%共聚焦激光显微镜%板层角膜切除%羊膜移植
真菌性角膜炎%共聚焦激光顯微鏡%闆層角膜切除%羊膜移植
진균성각막염%공취초격광현미경%판층각막절제%양막이식
Keratitis%Confocal laser microscope%Corneal lamellar resection%Amniotic membrane transplantation
目的 应用共聚焦显微镜判断真菌性角膜炎行板层角膜切除联合羊膜移植治疗后的转归.方法 对2010年1月至2011年6月在安阳市眼科医院门诊经共聚焦显微镜确诊为真菌性角膜炎患者30例30只眼,于角膜病灶未累积内皮层、给予抗真菌药物治疗1周后,行板层角膜病灶切除联合羊膜移植术.并分别在治疗前及治疗后7、14、21、28 d和3、6个月,应用共聚焦显微镜对患者角膜病灶的特定位点进行检查,观察视力变化、局部菌丝的有无、菌丝的密度、炎症细胞密度和形态的变化,以及感染区角膜基质细胞的变化;对手术治疗进行评估,同时为判断抗真菌药物的疗效提供依据,以此调整药物用量.对共聚焦显微镜未见真菌菌丝及炎症细胞的患者在巩固治疗1周后逐渐停药.结果 治疗前视力≤0.05者21只眼,0.05～0.2者9只眼.治愈后(治疗21 d)视力≤0.05者3只眼,0.05～0.2者24只眼,≥0.2者3只眼,治疗前后视力变化比较差异有统计学意义(Zc=4.2007,P＜0.01).结论 共聚焦显微镜检查是目前判断真菌性角膜炎药物治疗疗效理想手段,并能为临床调整用药提供客观依据.
目的 應用共聚焦顯微鏡判斷真菌性角膜炎行闆層角膜切除聯閤羊膜移植治療後的轉歸.方法 對2010年1月至2011年6月在安暘市眼科醫院門診經共聚焦顯微鏡確診為真菌性角膜炎患者30例30隻眼,于角膜病竈未纍積內皮層、給予抗真菌藥物治療1週後,行闆層角膜病竈切除聯閤羊膜移植術.併分彆在治療前及治療後7、14、21、28 d和3、6箇月,應用共聚焦顯微鏡對患者角膜病竈的特定位點進行檢查,觀察視力變化、跼部菌絲的有無、菌絲的密度、炎癥細胞密度和形態的變化,以及感染區角膜基質細胞的變化;對手術治療進行評估,同時為判斷抗真菌藥物的療效提供依據,以此調整藥物用量.對共聚焦顯微鏡未見真菌菌絲及炎癥細胞的患者在鞏固治療1週後逐漸停藥.結果 治療前視力≤0.05者21隻眼,0.05～0.2者9隻眼.治愈後(治療21 d)視力≤0.05者3隻眼,0.05～0.2者24隻眼,≥0.2者3隻眼,治療前後視力變化比較差異有統計學意義(Zc=4.2007,P＜0.01).結論 共聚焦顯微鏡檢查是目前判斷真菌性角膜炎藥物治療療效理想手段,併能為臨床調整用藥提供客觀依據.
목적 응용공취초현미경판단진균성각막염행판층각막절제연합양막이식치료후적전귀.방법 대2010년1월지2011년6월재안양시안과의원문진경공취초현미경학진위진균성각막염환자30례30지안,우각막병조미루적내피층、급여항진균약물치료1주후,행판층각막병조절제연합양막이식술.병분별재치료전급치료후7、14、21、28 d화3、6개월,응용공취초현미경대환자각막병조적특정위점진행검사,관찰시력변화、국부균사적유무、균사적밀도、염증세포밀도화형태적변화,이급감염구각막기질세포적변화;대수술치료진행평고,동시위판단항진균약물적료효제공의거,이차조정약물용량.대공취초현미경미견진균균사급염증세포적환자재공고치료1주후축점정약.결과 치료전시력≤0.05자21지안,0.05～0.2자9지안.치유후(치료21 d)시력≤0.05자3지안,0.05～0.2자24지안,≥0.2자3지안,치료전후시력변화비교차이유통계학의의(Zc=4.2007,P＜0.01).결론 공취초현미경검사시목전판단진균성각막염약물치료료효이상수단,병능위림상조정용약제공객관의거.
Objective To observe the effects that fungal keratitis treated by corneal lamellar resection combined with amniotic membrane transplantation using confocal microscopy.Methods Thirty patients (30 eyes),treated from January 2010 to June 2011,whose cornea lesion didn't involve the endothelial layer of cornea and diagnosed as fungal keratitis by confocal microscopy,were admitted into our study.All the patients received corneal lamellar resection combined with amniotic membrane transplantation after using antifungal medicine for one week.Confocal microscopy was used to observe the particular lesion of each eye,respectively,before and 7,14,21,and 28 days,3 and 6 month after the treatment.The changes of visual acuity were observed.Results Before treatment,visual acuity of 21 eyes was ≤0.05,9 in 0.05-0.2.The final visual acuity was that 3 eyes were ≤ 0.05,24 in 0.05 to 0.2,and 3 ≥ 0.2.The difference of decreasing visual acuity was statistically significant (Zc=4.2007,P ≤0.001).Conclusions Confocal microscopy is a fine choice to assess the effect of medicine treatment for fungal keratitis,and can provide an objective evidence for choosing medication in clinic.
