CAJ | 학술논문

目的分析角膜移植术后病毒性角膜内皮炎的临床特征,指导临床诊断与治疗.方法对2008年1月至2012年10月在山东省眼科研究所收治的24例确诊为角膜移植术后内皮炎的病例进行回顾性分析.分别记录其裂隙灯显微镜下角膜水肿的位置、范围、内皮面KP情况,激光共聚焦显微镜(Confocal)下内皮细胞形态、数量及内皮面KP情况,总结其临床特征及治疗转归.结果裂隙灯显微镜可见角膜植片和(或)植床水肿,水肿对应的内皮面出现散在、斑块状KP,KP均匀分布于受累植片及植床;Confocal下可见水肿对应植片与植床的内皮面均有多量炎症细胞浸润,内皮细胞水肿,失去六边形结构,边界模糊,细胞核增大;可见大小不一,形态各异的高反光KP,呈散在分布,聚集成团或条索状分布;可见暗区,暗区内细胞边界与细胞结构无法识别.应用抗病毒药物联合糖皮质激素治疗7～10 d后,患者病情得以控制,视力较治疗前均有不同程度的提高.药物治疗3个月后与发病前相比较,内皮细胞丢失率为(9.9±2.1)％.结论角膜移植术后出现植片水肿和内皮面KP要考虑病毒性角膜内皮炎的可能性,掌握其临床特征,有利于诊断和治疗.
목적 분석각막이식술후병독성각막내피염적림상특정,지도림상진단여치료.방법 대2008년1월지2012년10월재산동성안과연구소수치적24례학진위각막이식술후내피염적병례진행회고성분석.분별기록기렬극등현미경하각막수종적위치、범위、내피면KP정황,격광공취초현미경(Confocal)하내피세포형태、수량급내피면KP정황,총결기림상특정급치료전귀.결과 렬극등현미경가견각막식편화(혹)식상수종,수종대응적내피면출현산재、반괴상KP,KP균균분포우수루식편급식상;Confocal하가견수종대응식편여식상적내피면균유다량염증세포침윤,내피세포수종,실거륙변형결구,변계모호,세포핵증대;가견대소불일,형태각이적고반광KP,정산재분포,취집성단혹조색상분포;가견암구,암구내세포변계여세포결구무법식별.응용항병독약물연합당피질격소치료7～10 d후,환자병정득이공제,시력교치료전균유불동정도적제고.약물치료3개월후여발병전상비교,내피세포주실솔위(9.9±2.1)％.결론 각막이식술후출현식편수종화내피면KP요고필병독성각막내피염적가능성,장악기림상특정,유리우진단화치료.
Objective To summarize and analyze the clinical characteristics of viral corneal endotheliitis after corneal transplantation,and providing clinic guidance for diagnosis and treatment.Methods Twenty-four clinical cases with comeal endermatitis after keratoplasty referred to our hospital from January 2008 to October 2012 were retrospectively analyzed.Corneal edema,and the changes of endothelial surface KP were recorded under slit lamp microscope.The morphology and quantity of endothelial cell,along with the changes of endothelial surface KP also were examined by the laser scanning confocal microscope.Results Slit lamp microscope examinations showed that the corneal edema of graft and/or planting bed,and appearing scattered and patchy KP under endothelial surface,moreover,KP evenly distributed in the affected graft and planting beds.Confocal images revealed that:cell edema,highly inflammatory cell infiltration,loss of defined hexagonal cell boundaries,enlarged nuclei; different sizes and shapes of high reflective and scattered KP,gathered into a mass or cords; the visible dark areas with blurry borders and cell structure.After 710 days treatment by antiviral therapy combined with glucocorticoids,the patients' condition was controlled,and vision were improved than before.After 3 months treatment,the loss of endothelial cell was (9.9±2.1)％.Conclusions It needs consider the possibility of corneal endotheliitis when appearing graft edema,the surface endothelial and the change of KP after corneal transplantation,and grasping the clinical features,which plays an important role in improving the diagnostic level in our clinical practicing work.