CAJ | 학술논문

目的分析196例感染性角膜炎住院患者的发病特点及疾病转归,为地区性角膜病的防盲治盲工作提供参考依据.方法对2010年1月至2012年12月在荆州市中心医院眼科符合人选标准的196例感染性角膜炎患者的临床资料、发病特点、致病因素、实验室检查结果、治疗效果等进行回顾性分析.结果 196例(198只眼)感染性角膜炎中,男性118例120只眼,女性78例78只眼.发病平均年龄58.6岁,主要集中于41～60岁.主要致病因素为角膜外伤、继发眼表感染、角膜接触镜的配戴、皮质类固醇的使用以及继发手术感染.根据临床表现及实验室检查结果,诊断为真菌性角膜炎128例128只眼(65.3％),居感染的首位,病毒性角膜炎47例49只眼(24.0％),细菌性角膜炎患者21例21只眼(10.7％).在真菌性角膜炎中,角膜刮片直接镜检法的诊断阳性率为67.2％.123例培养结果中,46例呈阳性,其中细菌8例,真菌38例.患者从发病至来院就诊时间为1～90 d,平均(32±7.4)d.60例患者接受手术治疗,其中24例行病灶清创联合球结膜遮盖术,12例行病灶清创联合羊膜移植及结膜瓣遮盖,8例转上级医院行角膜移植术,最终行眼内容物剜除16例,包括3例羊膜移植手术失败者.结论真菌性角膜炎是感染性角膜炎住院患者的主要病因,其次为病毒性.近年来,真菌性角膜炎发病率呈明显上升趋势,药物治疗无效时,行病灶清创联合羊膜移植和(或)球结膜遮盖可以有效降低患者视力丧失,挽救眼球,值得推广.
목적 분석196례감염성각막염주원환자적발병특점급질병전귀,위지구성각막병적방맹치맹공작제공삼고의거.방법 대2010년1월지2012년12월재형주시중심의원안과부합인선표준적196례감염성각막염환자적림상자료、발병특점、치병인소、실험실검사결과、치료효과등진행회고성분석.결과 196례(198지안)감염성각막염중,남성118례120지안,녀성78례78지안.발병평균년령58.6세,주요집중우41～60세.주요치병인소위각막외상、계발안표감염、각막접촉경적배대、피질류고순적사용이급계발수술감염.근거림상표현급실험실검사결과,진단위진균성각막염128례128지안(65.3％),거감염적수위,병독성각막염47례49지안(24.0％),세균성각막염환자21례21지안(10.7％).재진균성각막염중,각막괄편직접경검법적진단양성솔위67.2％.123례배양결과중,46례정양성,기중세균8례,진균38례.환자종발병지래원취진시간위1～90 d,평균(32±7.4)d.60례환자접수수술치료,기중24례행병조청창연합구결막차개술,12례행병조청창연합양막이식급결막판차개,8례전상급의원행각막이식술,최종행안내용물완제16례,포괄3례양막이식수술실패자.결론 진균성각막염시감염성각막염주원환자적주요병인,기차위병독성.근년래,진균성각막염발병솔정명현상승추세,약물치료무효시,행병조청창연합양막이식화(혹)구결막차개가이유효강저환자시력상실,만구안구,치득추엄.
Objective To investigate the general features,epidemiology and sequelae of 196 infectious keratitis in Jingzhou Region,and to provide proper evidences for blindness prevention.Methods Retrospective review of the general features,predisposing factors,laboratory examination and treatment effectiveness were collected and analyzed in 196 patients with confirmed infectious keratitis in our hospital from January 2010 to December 2012.Results Among the 196 patients (198eyes),118 (120 eyes) were male and 78 (78 eyes) were female with mean age at 58.6 years.The age distribution was mainly 41-60 years old.The important risk factors were corneal trauma,ocular surface disease,contact lens wear,steroid use and previous ocular surgery.The leading infectious keratitis was fungal keratitis (128 patients,128 eyes,63.5％) and followed by viral keratitis (47 patients,49 eyes,30.0％).Twenty-one patients (21 eyes,10.7％) were confirmed with bacterial keratitis.The positive rate of direct microscopic examination of corneal scraping was 67.2％ in fungal keratitis.In 123 cultured specimens,46 cases (37.4％) were detected positive,8 showed bacterial growth,and 38 demonstrated fungal growth.The median time from inciting event to receiving treatment in our hospital was 32±7.4d.Sixty eyes received operation.Among them,26 eyes undertook local debridement with conjunctival flap covering,12 eyes received local debridement with amniotic membrane transplantation and conjunctival flap covering,8 patients went to higher hospital for keratoplasty,and 17 eyes received enucleation finally.Conclusions Fungal keretitis is the major cause of corneal infections and is followed by viral keratitis in Jingzhou Central Hospital.An incremental increase is seen in the number of fungal keratitis cases and bacterial keratitis show a decline during the study period.This disconcerting trend and the fairly high rate of blindness resulting in infectious keratitis warrant further research.Patients with infectious keratitis have generally poor visual outcomes and accepted treatment promptly may improve the outcome.Local debridement with conjunctival flap covering and/or amniotic membrane transplantation is a method reserved to be recommended when drug treatment is unhelpful.