棘阿米巴角膜炎研究进展

棘阿米巴角膜炎系棘阿米巴原虫感染引起的一种顽固性、进行性角膜炎,为严重的眼部感染性疾病.棘阿米巴原虫大量存在于自来水、角膜接触镜护理液等中,随着角膜接触镜佩戴人数的增多,该病的发生有迅速增加的趋势.棘阿米巴角膜炎的诊断主要依靠病史、临床症状和实验室诊断,尤其是后者在近年来的研究中进展较快.棘阿米巴角膜炎的治疗主要是药物治疗和手术治疗,其中准分子激光角膜切削术已成为一种新的治疗方法.就棘阿米巴角膜炎的病原学、诊断和治疗方面的研究进展进行综述.     

Bakterielle Keratitis – aktuelle Aspekte zur Diagnostik

Keratitis remains the third most common etiology for blindness worldwide. Whereas bacteria still predominate as causative organisms in temperate climates, fungal and mixed infections are more common in tropical and semitropical areas. In recent years, a shift in the causative organisms, as well as predisposing factors, has been reported. Risk factors that may have gained in importance, such as wearing contact lenses and corneal surgery, have been identified. Microorganisms, especially Pseudomonas spp. and mycobacteria have been frequently isolated in these patients. A changing pattern in microorganism infection has been observed that might be caused by inappropriate use of potent antimicrobial agents. Because of the sight threatening nature of bacterial keratitis, proper diagnosis and antibiotic selection are required. Management should be guided by the appropriate diagnosis, severity of clinical symptoms and underlying risk factors. Molecular techniques, such as polymerase chain reaction, have increased our diagnostic options, even when they cannot replace established procedures. This article reviews the current data and procedures available for the diagnosis of bacterial keratitis.     

Selection of appropriate antifungal therapy

Although there have been no radical breakthroughs in the treatment of fungal keratitis from the point of view of new antifungal agents, a better understanding of the epidemiology and pathology of the disease, as well as the drugs available and the appropriate surgical interventions, has led to an improvement in the management of this difficult corneal infection. In this paper the therapy of fungal keratitis will be reviewed in detail in the light of the known causative organisms and the pharmacology and pharmacokinetics of available antifungal agents.     

Microbial investigations in keratitis at the Sydney Eye Hospital

Abstract
We investigated 107 cases of presumed microbial keratitis amongst patients presenting to the Sydney Eye Hospital between October 1986 and August 1988 to determine the frequency of infection, the common causative organisms and those factors that predispose to corneal infection.
We found that 95% of culture-proven cases were caused by bacteria and that Staphylococcus epidermidis and Corynebacterium sp, accounted for 42.5% of these cases. All bacteria (except Staphylococcus epidermidis and Mycobacrerium chelonae ) were sensitive to gentamicin.
In 62.6% of cases, cultures for bacteria and fungi were negative. Retrospective review of the clinical records of these patients showed that herpes simplex virus, contact lens wear, staphylococcal marginal keratitis and recurrent erosion were important causes of keratitis in this group.     

准分子激光角膜屈光手术后疱疹病毒性角膜炎的研究进展

准分子激光角膜屈光手术后并发单纯疱疹病毒（HSV）感染常可引起视力的严重损害。导致准分子激光角膜屈光手术后并发疱疹病毒感染的主要原因有：准分子激光照射和手术刺激诱发潜伏的HSV活化;术后局部长期应用糖皮质激素类滴眼液,也可是上述因素综合作用的结果。及时诊断及有效的抗病毒治疗是恢复视力的关键,血清抗体检测、病毒培养、角膜上皮刮片、组织细胞切片和Negative染色、聚合酶链反应（PCR）等实验室检测均存在一定的限制,而多重PCR可能会成为有效的实验室诊断方法。准分子激光角膜屈光手术后并发HSV感染的治疗方法主要是根据病情局部或全身应用抗病毒药物,对于术前曾有单纯疱疹病毒性角膜炎（HSK）病史的患者围手术期局部给予抗病毒药物可显著降低准分子激光角膜屈光手术后疱疹病毒感染的发生率。根据近年来国内外相关的临床研究及基础研究,对准分子激光角膜屈光手术后合并HSK的病因、诊断、治疗及预防进行综述。     

Microbial investigations in keratitis at the Sydney Eye Hospital

We investigated 107 cases of presumed microbial keratitis amongst patients presenting to the Sydney Eye Hospital between October 1986 and August 1988 to determine the frequency of infection, the common causative organisms and those factors that predispose to corneal infection. We found that 95% of culture-proven cases were caused by bacteria and that Staphylococcus epidermidis and Corynebacterium sp. accounted for 42.5% of these cases. All bacteria (except Staphylococcus epidermidis and Mycobacterium chelonae) were sensitive to gentamicin. In 62.6% of cases, cultures for bacteria and fungi were negative. Retrospective review of the clinical records of these patients showed that herpes simplex virus, contact lens wear, staphylococcal marginal keratitis and recurrent erosion were important causes of keratitis in this group.     

Revisión de la literatura sobre la evidencia disponible actualmente para el manejo de las queratitis infecciosas con PACK-CXL

Infectious keratitis (IK) is one of the most common causes of monocular blindness worldwide, especially in developing countries, and may account for 5.1 to 32.3% of all indications for penetrating keratoplasty (PK). However, performing a therapeutic PK on a “hot eye” is associated with a higher incidence of IK recurrence and graft rejection. Standard treatment includes antimicrobials (ATM) and, once the causative pathogen has been identified, must be continued with targeted treatment, depending on antibiogram sensitivity. However, appearance of multiresistant strains to ATM is progressively increasing at an alarming rate. Besides that, the diversity of the causative microorganisms (bacteria, fungi, parasites, viruses) may hinder the clinical diagnosis and secondarily the proper treatment from the beginning. It is estimated that only 50% of eyes will have a good visual result if the correct therapy is delayed. All these factors make the identification of alternatives to ATM treatment of paramount importance. Due to the ATM properties of photoactivated chromophore (riboflavin) and ultraviolet light of wavelength 200-400 nm, used in multiple medical and non-medical applications for disinfection, photoactivated chromophore for corneal cross-linking (CXL) of IK, as an addition to the therapeutic arsenal for the management of IK has been proposed. It must be differentiated from CXL used for the management of progressive keratoconus. The objective of this review is to update the available evidence on the efficacy and safety of photoactivated chromophore for corneal CXL in IKs.     

角膜塑形术致感染性角膜溃疡的临床分析

目的分析总结16例角膜塑形术(orthokeratology,OK)镜治疗过程中发生的绿脓杆菌、真菌和棘阿米巴性角膜溃疡的临床过程、治疗经过及转归.方法根据感染病原微生物的不同,用微生物学方法对16例行OK镜治疗致角膜溃疡患者进行检测,采取不同的敏感药物治疗,对9例角膜感染严重、药物治疗不能控制或濒于穿孔的患者,行板层或穿透性角膜移植术.总结并分析其临床转归及治疗效果.结果 16例中,角膜刮片细长杆菌7例,棘阿米巴7例,真菌1例,未检出1例.角膜溃疡刮片培养铜绿假单胞菌7例,棘阿米巴7例,真菌1例,未检出致病菌者1例.治疗药物治疗7例,板层角膜移植术6例,穿透性角膜移植术3例.治疗后视力＞0.1者7例,0.02～0.1者4例, ＜0.02者5例.结论感染性角膜溃疡是OK治疗近视最严重的并发症,应积极抗感染治疗,必要时应及时行角膜移植术.虽然最终感染可得以控制,但明显损害患者视力.     

Diagnostic armamentarium of infectious keratitis: A comprehensive review

Infectious keratitis (IK) represents the leading cause of corneal blindness worldwide, particularly in developing countries. A good outcome of IK is contingent upon timely and accurate diagnosis followed by appropriate interventions. Currently, IK is primarily diagnosed on clinical grounds supplemented by microbiological investigations such as microscopic examination with stains, and culture and sensitivity testing. Although this is the most widely accepted practice adopted in most regions, such an approach is challenged by several factors, including indistinguishable clinical features shared among different causative organisms, polymicrobial infection, long diagnostic turnaround time, and variably low culture positivity rate. In this review, we aim to provide a comprehensive overview of the current diagnostic armamentarium of IK, encompassing conventional microbiological investigations, molecular diagnostics (including polymerase chain reaction and mass spectrometry), and imaging modalities (including anterior segment optical coherence tomography and in vivo confocal microscopy). We also highlight the potential roles of emerging technologies such as next-generation sequencing, artificial intelligence-assisted platforms. and tele-medicine in shaping the future diagnostic landscape of IK.     

2000至2009年角膜移植手术适应证变化趋势的研究

目的 探讨2000至2009年山东省眼科研究所青岛眼科医院开展角膜移植手术的手术适应证,并比较前5年与后5年手术适应证的变化.方法 对2000年1月至2009年12月山东省眼科研究所青岛眼科医院行角膜移植手术病例的资料进行回顾性调查.2000至2009年角膜移植术3649例(3741只眼)资料完整,其中男性2518例(2582只眼),女性1131例(1159只眼);穿透性角膜移植术(PKP)2594例(2667只眼),板层角膜移植术(LKP)1055例(1074只眼).分析2000至2004、2005至2009年2个时间段角膜移植手术的适应证及其变化.结果 前5年PKP适应证依次为化脓性角膜炎(440例,442只眼)、圆锥角膜(241例,274只眼)、病毒性角膜炎(229例,229只眼),LKP适应证依次为化脓性角膜炎(221例,221只眼)、角膜烧伤(包括角膜化学伤和热烫伤;106例,106只眼)、其他原因(包括泡性角膜炎、角膜基质炎等;79例,79只眼),PKP(1352只眼)与LKP(548只眼)之比为2.5∶1.0.后5年PKP适应证依次为化脓性角膜炎(330例,330只眼)、病毒性角膜炎(124例,124只眼)、圆锥角膜(99例,105只眼),LKP适应证依次为化脓性角膜炎(230例,236只眼)、圆锥角膜(97例,101只眼)、角膜营养不良和角膜变性(42例,49只眼),PKP(876只眼)与LKP(508只眼)之比为1.7∶1.0.结论 化脓性角膜炎是角膜移植手术的主要适应证,LKP术式的选择明显增加,已成为化脓性角膜炎、圆锥角膜的首选手术方式.

Abstract：

Objective To analyzed retrospectively the indications of corneal transplantations,including penetrating keratoplasty(PKP) , lamellar keratoplasty (LKP) and corneal transplantation combined with anterior and posterior segment surgery in Qingdao Eye Hospital, Shandong Eye Institute. And compare the changes of the indications between the first five years and the last five years. Methods The patients who received PKP, LKP and corneal transplantation combined with anterior and posterior segment surgeries in Qingdao Eye Hospital, Shandong Eye Institute between January 2000 and December 2009 were reviewed retrospectively. From 2000 to 2009, 3649 cases(3741 eyes)of corneal transplantations have complete data,including male 2518 cases(2582 eyes) ,female 1131 cases (1159 eyes) ;PKP 2594 cases (2667 eyes) ,LKP 1055 cases (1074 eyes). Compare and analysis the indications and its changes between 2000 -2004and 2005 - 2009 two periods . Results During the first period, the leading indications for PKP, in order of decreasing frequency, were purulent keratitis (440 cases, 442 eyes) , keratoconus (241 cases, 274 eyes) ,herpes simplex keratitis ( HSK) (229 cases, 229 eyes) , the leading indications for LKP were purulent keratitis (221 cases, 221 eyes), corneal burn (including thermal and chemical burn) (106 cases, 106eyes) , others (mainly refers to the phlyctenular keratitis, interstitial keratitis, et al) (79 cases, 79 eyes) ,the ratio of PKP and LKP is 2. 5 to 1. 0. During the second period the leading indications for PKP, in order of decreasing frequency, were purulent keratitis (330 cases, 330 eyes), HSK (124 cases, 124 eyes),keratoconus (99 cases, 105 eyes), the leading indications for LKP were purulent keratitis (230 cases,236 eyes) , keratoconus(97 cases, 101 eyes) , corneal dystrophy and degeneration (42 cases, 49 eyes) ,the ratio of PKP and LKP is 1.7 to 1. 0. Conclusions Purulent keratitis is the main indication of corneal transplantion, the choice of LKP significantly increase. LKP has become the first surgical choice of purulent keratitis and keratoconus.     

Infectious keratitis: an update on epidemiology,causative microorganisms,risk factors,and antimicrobial resistance

Corneal opacity is the 5th leading cause of blindness and visual impairment globally, affecting ~6 million of the world population. In addition, it is responsible for 1.5–2.0 million new cases of monocular blindness per year, highlighting an ongoing uncurbed burden on human health. Among all aetiologies such as infection, trauma, inflammation, degeneration and nutritional deficiency, infectious keratitis (IK) represents the leading cause of corneal blindness in both developed and developing countries, with an estimated incidence ranging from 2.5 to 799 per 100,000 population-year. IK can be caused by a wide range of microorganisms, including bacteria, fungi, virus, parasites and polymicrobial infection. Subject to the geographical and temporal variations, bacteria and fungi have been shown to be the most common causative microorganisms for corneal infection. Although viral and Acanthamoeba keratitis are less common, they represent important causes for corneal blindness in the developed countries. Contact lens wear, trauma, ocular surface diseases, lid diseases, and post-ocular surgery have been shown to be the major risk factors for IK. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though its effectiveness is being challenged by the emergence of antimicrobial resistance, including multidrug resistance, in some parts of the world. In this review, we aim to provide an updated review on IK, encompassing the epidemiology, causative microorganisms, major risk factors and the impact of antimicrobial resistance.Subject terms: Corneal diseases, Epidemiology, Risk factors     

1999至2009年温州地区角膜移植手术的临床分析

目的 分析1999年9月至2009年12月在浙江省温州医学院附属眼视光医院施行角膜移植手术病例的病因以及手术方式的变化趋势.方法 调查研究.统计1999年9月至2009年12月在眼视光医院施行角膜移植手术患者的病因,并记录患者的年龄、性别、籍贯、诊断、手术方式等相关信息,把上述信息输入Excel表格中,进行描述性分析,计算百分比,结果用各种统计图表来表示.结果 这10年间行角膜移植手术患者的年龄分布呈正态性,平均为44.4岁,高峰在50～59岁.男性患者多于女性患者,男性患者在细菌件角膜病变和外伤中所占的百分比明显高于女性.近2/3患者来源于温州地区.共对651例患者(727眼)施行了角膜移植手术,其中439例(495眼)行穿透性角膜移植术,103例(123眼)行深板层角膜移植术,62例(62眼)行板层角膜移植术,40例(40眼)行穿透性角膜移植联合白内障摘除手术,7例(7眼)行其他类型角膜移植手术.最常见的病因为感染性角膜病变,168眼(23.1%),其中细菌性角膜溃疡86眼(11.8%),真菌性角膜溃疡82眼(11.3%).其他的有单纯疱疹病毒性角膜炎165眼(22.7%),角膜白斑(包括先天性白斑以及感染愈合后遗留的白斑)95眼(13.1%),外伤(包括化学伤、热烧伤、爆炸伤以及外伤后角膜疤痕)64眼(8.8%),圆锥角膜58眼(8.0%),大泡性角膜病变(人工晶状体眼或无晶状体眼)57眼(7.8%),角结膜皮样瘤(包括Goldenharr综合征)43眼(5.9%)以及各种类型角膜营养不良和变性41眼(5.6%),24眼(3.3%)为再次移植.穿透性角膜移植手术量从2005年后有逐渐下降趋势,而板层和深板层角膜移植手术量有逐渐增加趋势.结论 感染性角膜病变是温州地区角膜移植最常见的病因,单纯疱疹病毒性角膜炎是单病种中最多见的病因.本次研究结果和中国北部地区结果相似,和欧美国家结果有所不同.对于内皮功能正常的患者,深板层角膜移植术将逐渐取代穿透性角膜移植术.     

Collagen Cross-Linking in the Management of Microbial Keratitis

Increasing resistance to antimicrobial agents has contributed to an elevated risk of complications of infectious keratitis. Corneal collagen cross-linking (CXL) has been widely adopted for the management of keratoconus and post-refractive surgery corneal ectasia. It has recently been introduced as an option for treating keratitis due to multidrug resistant organisms. The purpose of this review is to discuss the rationale, safety, and evidence for CXL in infectious keratitis and its possible effect on ocular surface inflammation. Published data show that CXL is effective and safe as an adjunct to antibiotic treatment in selected cases of bacterial keratitis. The benefit of CXL probably varies according to the etiology of the infection.     

Indications for penetrating keratoplasty in East China, 1994–2003

Purpose To evaluate the indications for penetrating keratoplasty (PKP) and associated procedures in the Eye and ENT Hospital, Fudan University, Shanghai, People’s Republic of China, an eye center in East China and to compare our results with those from previous studies. Methods We retrospectively studied the charts of cases who had received PKP in the hospital from 1994 to 2003. The recorded data covered age, sex, and preoperative clinical diagnoses of PKP, and surgical procedures in some cases. Results A total of 229 cases received PKP during that period. The number of surgical cases increased dramatically in the last 3 years (2001–2003). The leading indication for PKP was corneal scar (55.9%), which included 44 (19.2%) cases of corneal scar after viral keratitis and 30 (13.1%) cases of corneal scar after chemical/thermal burn. Other indications, in order of decreasing frequency, were bullous keratopathy (12.2%), acute necrotizing/ulcerative keratitis (12.2%), regraft (10.5%), keratoconus (5.7%), and non–Fuchs’ corneal dystrophies (3.8%). Combined procedures were performed on 22 cases. The most three common indications for PKP, corneal scar, bullous keratopathy, acute necrotizing/ulcerative keratitis, showed an increasing frequency in the period of the last 3 years. Conclusion The leading indication for PKP was corneal scar, which differed from the conclusion offered by the developed areas in the world, where bullous keratopathy or keratoconus was the case. A similar result was also found in reports from India and Taiwan.     

A partial-thickness epithelial defect increases the adherence of Pseudomonas aeruginosa to the cornea

Some patients with infectious keratitis have no clinically demonstrable corneal abrasion predisposing them to infection. Subtle, undetectable corneal injuries may facilitate bacterial adherence to the cornea, eventually leading to keratitis. To study this concept, we have developed a rabbit model in which a partial-thickness corneal epithelial defect was induced by filter paper impression on the cornea that removed one to two layers of corneal epithelium. Following this injury, the corneas were incubated with Pseudomonas aeruginosa, washed, and the number of bacteria adhering to the injured corneas as well as to control corneas was quantitated. Corneas treated with filter paper, either ex vivo or in vivo, allowed 20 times more bacteria to adhere than did the untreated control corneas (P less than 0.01). This superficial epithelial defect increased Pseudomonas adherence to the cornea for up to 72 hr after injury. When corneal injury was extended to the stroma, the adherence of Pseudomonas was further augmented as compared to adherence to the superficially injured cornea. Thus, we conclude that a clinically subtle, partial-thickness corneal epithelial injury can markedly facilitate the adherence of Pseudomonas aeruginosa, which may be an important predisposing factor for infectious keratitis.     

Efficacy of cyanoacrylate tissue adhesive in the management of corneal thinning and perforation due to microbial keratitis

PurposeReport the efficacy of cyanoacrylate tissue adhesive (CTA) application in the management of corneal thinning and perforations associated with microbial keratitis.MethodsA retrospective review of consecutive patients who underwent CTA application for corneal thinning and perforation secondary to microbiologically proven infectious keratitis between 2001 and 2018 at a single center. We defined successful CTA application as an intact globe without tectonic surgical intervention.ResultsThe cohort included 67 patients, and 37 presented with corneal perforation while 30 had corneal thinning. The perforation/thinning was central/paracentral in 43 eyes and peripheral in 23 eyes. The underlying infectious etiologies were monomicrobial in 42 cases (35 bacterial, 3 fungal, 2 viral, and 2 acanthamoeba cases) and polymicrobial in 25 cases (22 polybacterial cases and 3 cases with a combination of Gram positive bacteria and fungus). The median duration of glue retention was 29 days. The CTA success rate was 73%, 64%, and 44% at 10, 30, and 180 days, respectively. CTA application appears more successful in monomicrobial (vs. polymicrobial) and Gram positive bacterial (vs. Gram negative) keratitis but the differences are statistically non-significant. The location of perforation/thinning and the use of topical corticosteroid were not associated with CTA failure.ConclusionCTA was moderately effective in restoring globe integrity in severe corneal thinning and perforation secondary to microbial keratitis in the short term. However the majority of patients require tectonic surgical intervention within 6 months. CTA application success is not significantly associated with the location of thinning/perforation or the use of topical corticosteroid.     

Contact lens-related microbial keratitis: how have epidemiology and genetics helped us with pathogenesis and prophylaxis

Contact lens wear is a common predisposing factor in microbial keratitis and is one of the two preventable risk factors for corneal infection in a working age population. Our understanding of the prevention and prophylaxis of contact lens-related corneal infection is informed by recent epidemiological studies describing the incidence of and risk factors for the disease, the effect of causative organism on disease severity, and an appreciation of individual immune profiles in susceptibility to and severity of the disease. Although contemporary contact lenses have not reduced the overall incidence of keratitis, a reduction in morbidity may be achievable through recognition of appropriate risk factors in severe disease, including avoiding delays in presenting for appropriate treatment, and attention to storage case hygiene practise. Severe keratitis is most commonly associated with an environmental causative organism, and daily disposable lenses are associated with less severe disease. Pseudomonas aeruginosa remains the commonest cause of contact lens-related corneal infection probably because of its unique virulence characteristics and ability to survive in the contact lens/storage case/ocular environment. In two recent outbreaks of contact lens-related infections, there has been a strong association demonstrated with particular contact lens solutions. Since the recall of these specific contact lens solutions, the rate of Acanthamoeba keratitis has remained above the expected baseline, indicating unidentified risk factors that may include environmental exposures. Individual differences in susceptibility to microbial keratitis may be partly explained by differences in single-nucleotide polymorphisms in certain cytokine genes, particularly those with a proven protective role in corneal infection.     

Infectious Keratitis Following Corneal Crosslinking: A Systematic Review of Reported Cases: Management,Visual Outcome,and Treatment Proposed

Aim: To describe the infectious complications and the group of pathogens involved in the infection following corneal crosslinking, the visual outcome, and the treatment proposed. Methods: A Medline (National Library of Medicine, Bethesda, MD, USA) search from October 2000 to October 2013 was performed to identify all articles describing infectious keratitis following corneal crosslinking treatment. Nineteen articles were selected. Ten articles reported infectious complications of corneal crosslinking treatment were included. Nine articles were excluded, because seven described sterile keratitis, one article was in German, and one reported general complication without describing the infection complication. Results: A total number of infections reported included 10 eyes. The infectious keratitis was associated with bacteria in five eyes (50%): gram-positive bacteria in three eyes (30%) (staphylococcus epidermidis, S. aureus and streptococcus salivarius plus S. oralis, respectively) and gram-negative bacteria in two eyes (20%) (E. coli; P. aeruginosa); there was herpes virus in two eyes, fungus in two eyes (Fusarium and Microsporidia) (20%), and Acanthamoeba in one eye (10%). Conclusions: Only 10 cases of infectious keratitis following corneal crosslinking are published. The most virulent pathogens were Pseudomonas aeruginosa and Acanthamoeba. Less virulent organisms were Escherichia coli and S. epidermidis. Two cases of herpes keratitis were described, suggesting the possibility of systemic antiviral prophylaxis before corneal crosslinking treatment. The most common risk factor of infections identified was postoperative incorrect patient behavior.     

Bacterial keratitis: identifying the areas of clinical uncertainty

Bacterial keratitis is a common corneal infection that is treated with topical antimicrobials. By the time of presentation there may already be severe visual loss from corneal ulceration and opacity, which may persist despite treatment. There are significant differences in the associated risk factors and the bacterial isolates between high income and low- or middle-income countries, so that general management guidelines may not be appropriate. Although the diagnosis of bacterial keratitis may seem intuitive there are multiple uncertainties about the criteria that are used, which impacts the interpretation of investigations and recruitment to clinical studies. Importantly, the concept that bacterial keratitis can only be confirmed by culture ignores the approximately 50% of cases clinically consistent with bacterial keratitis in which investigations are negative. The aetiology of these culture-negative cases is unknown. Currently, the estimation of bacterial susceptibility to antimicrobials is based on data from systemic administration and achievable serum or tissue concentrations, rather than relevant corneal concentrations and biological activity in the cornea. The provision to the clinician of minimum inhibitory concentrations of the antimicrobials for the isolated bacteria would be an important step forward. An increase in the prevalence of antimicrobial resistance is a concern, but the effect this has on disease outcomes is yet unclear. Virulence factors are not routinely assessed although they may affect the pathogenicity of bacteria within species and affect outcomes. New technologies have been developed to detect and kill bacteria, and their application to bacterial keratitis is discussed. In this review we present the multiple areas of clinical uncertainty that hamper research and the clinical management of bacterial keratitis, and we address some of the assumptions and dogma that have become established in the literature.     

组织工程角膜研究和应用进展

中国角膜供体材料的严重缺乏导致众多的角膜盲患者不能通过角膜移植来复明仍是临床棘手的问题。近年来,细胞生物学、组织工程学和材料学的发展为替代人角膜材料开辟了更广阔的前景;而且以深板层移植和内皮移植为代表的成分板层移植的推陈出新从临床技术上有力地推动了组织工程角膜的研发。现就脱细胞角膜基质板层材料、上皮细胞和内皮细胞组织工程的基础研究和临床应用进展进行述评。