感染性角膜炎的角膜移植术

目的 评价感染性角膜炎角膜移植治疗的临床效果.方法 采用深板层或穿透性角膜移植治疗真菌性角膜溃疡97例(97眼),病毒性伯膜炎21例(21眼),棘阿米巴性角膜炎3例(3眼),共121例(121眼).临床观察2～20月.结果 119眼角膜植片存活,治愈率98.35%;2例复发,复发率1.65%.结论 对药物治疗无效的感染性角膜炎及时行治疗性角膜移植术,是控制感染,挽救眼球,甚至恢复有用视力的有效方法.     

羊膜移植术治疗真菌性角膜溃疡的疗效观察

目的:观察羊膜移植治疗真菌性角膜溃疡的治疗效果。方法:对26例26眼药物治疗效果较差的真菌性角膜溃疡患者在彻底清除角膜病灶后联合羊膜移植术。结果:随访3～36mo,术后21眼角膜溃疡愈合,其中7眼角膜恢复透明,14眼角膜形成局限性斑翳或白斑。26眼中21眼(81%)的视力有不同程度提高。结论:羊膜移植术是治疗真菌性角膜溃疡一种较好的方法。     

碘酊烧灼后羊膜移植联合氟康唑应用治疗真菌性角膜溃疡的疗效分析

目的探讨和评价碘酊烧灼后羊膜移植联合氟康唑对真菌性角膜溃疡的疗效。方法对门诊收的20例（22眼）确诊为真菌性角膜溃疡,施以碘酊烧灼并行羊膜移植术,术后全身及局部氟康唑应用。结果随访3-12个月。其中17眼角膜溃疡愈合,视力有所提高;2眼角膜溃疡愈合后形成角膜瘢痕,视力降低;3眼角膜溃疡未能愈合建议行角膜移植术。结论碘酊烧灼后羊膜移植联合氟康唑应用是治疗真菌性角膜溃疡疗效较好且经济方便的方法之一。     

角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎

目的:总结角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎的效果。方法:收集2010-09/2011-09在我院就诊的真菌性角膜炎患者30例,对患者进行常规角膜刮片检查,并对全部患者施行角膜溃疡清创术,根据角膜炎的严重程度联合给予氟康唑或那他霉素眼水点眼治疗,清创术治疗无效者采用自体结膜覆盖术及板层角膜移植术治疗,随访观察治疗效果。结果:角膜刮片阳性结果 27例,阳性率90%,2例于外院行共聚焦显微镜检查菌丝阳性;1例为明确植物外伤史的8岁儿童,不能配合真菌检查。轻度角膜炎6例,施行角膜溃疡清创术联合氟康唑眼水点眼治疗全部痊愈,病程2～3wk;中度度角膜炎17例,行角膜溃疡清创术联合那他霉素眼水点眼治疗痊愈12例,病程4～8wk;重度角膜炎7例,行角膜溃疡清创术联合那他霉素眼水点眼治疗痊愈3例,病程8～10wk。角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎有效率70%。结论:角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎操作简单,是一种经济、有效、可行的治疗方式。     

使用猪角膜脱细胞基质的人板层角膜移植治疗真菌性角膜炎的临床观察

目的:观察猪角膜脱细胞基质构建的生物角膜支架用于人角膜板层移植术治疗药物难以控制的浅层真菌性角膜炎的效果.方法:对2015-06/2016-03我院收治的16例16眼真菌性角膜炎患者的临床资料进行回顾性分析.16例真菌性角膜炎进行猪角膜脱细胞基质移植,术后随访6mo.对患者术后视力、角膜植片情况、并发症及复发情况进行分析.结果:术后7~10d植片角膜上皮化.16例病例术后1mo角膜水肿,1mo后角膜水肿消失,角膜逐渐透明.术后1mo有2例出现术眼角膜上皮缺损,药物治疗均恢复.术后出现眼压高3例,给予降眼压治疗后眼压控制.随访期间未出现角膜溶解、感染复发、排斥现象.术后1、3、6mo视力分别为1.27±0.22,1.11±0.13,0.79±0.22,术后视力均较术前明显提高,术后1mo视力与术前相比无统计学差异(P=0.06),术后3、6mo视力与术前相比具有明显统计学差异(P=0.01、0.001);其中术后3mo与术后1mo视力相比无明显提高,结果无统计学差异(P=0.11),而术后6mo视力较术后1、3mo均有明显提高,结果具有显著统计学差异(P<0.001).结论:猪角膜脱细胞基质移植治疗真菌性角膜炎是安全、有效的方法.     

真菌性角膜炎的联合用药及手术治疗

目的：探讨联合用药及手术治疗真菌性角膜炎的临床效果。方法：对115例经10％KOH湿片或湿片墨汁法直接镜检查到真菌菌丝或孢子确认为真菌性角膜炎者进行菌属鉴别和体外抗真菌药物敏感试验，应用氟康唑静滴联合局部应用二性霉素B、氟康唑、酮康唑和三唑粉及制霉菌素药粉滴眼或5％那他霉素眼液治疗1周，无效且视力＜0．1者选择手术。结果：本组115眼中48眼经药物治疗病情痊愈，32眼行板层角膜移植，35眼行穿透性角膜移植。术后平均随访11个月，植片透明39眼（58．20％），混浊26眼（38．80％）。真菌病灶复发3眼（4．47％），其中1眼经药物治疗后感染控制，2眼药物治疗无效。结论：真菌性角膜炎应早期辅助实验室诊断，早期联合用药或手术治疗。     

两性霉素B角膜基质内注射成功治疗真菌性角膜炎1例

目的:报告1例使用5mg/L两性霉素成功治疗难治性真菌性角膜炎的病例。方法:病例报告。结果:女性患者1例,48岁,以右眼红1wk,伴视力下降和角膜混浊2d入院。否认有外伤或异物史。检查发现:右眼视力:6/12,针孔视力:6/18。注射结膜前使眼分泌物保持最少。角膜旁中央区有一全层基质脓肿-形态不规则且伴有卫星病灶及羽状边缘,不伴有上皮缺损,有前房积脓液平。左眼正常。诊断为真菌性角膜炎。尽管在此前患者经历了3wk的局部两性霉素B点眼(1次/2h),那他霉素眼液点眼(1次/4h),但并无病情恢复的迹象。相反12点出现了一个新的更大的基质脓肿病灶。我们应用5mg/L两性霉素B角膜基质注射联合穿透性角膜移植术治疗后溃疡面积明显减少,前房积脓完全消失,没有毒性反应发生。患者干预后2mo视力恢复了正常视力(6/6)。结论:使用两性霉素B5mg/L基质内注射,使用过程安全有效,是一种治疗难治性真菌性角膜炎的理想方法。     

深层板层角膜切除治疗真菌性角膜炎的效果

目的探讨深层板层角膜切除手术联合药物治疗真菌性角膜炎的临床疗效。方法对23例（23眼）直接镜检查到菌丝和／或孢子，确认为真菌性角膜炎者，尽早进行深层板层角膜切除联合抗真菌药物治疗。结果23例痊愈20例视力均有不同程度提高。复发1例、再次手术而治愈。结论真菌性角膜炎在无条件行角膜移植手术时，易尽早行深层板层角膜切除联合药物治疗。     

准分子激光原位角膜磨镶术后DLK的临床治疗

目的:探讨准分子激光原位角膜磨镶术后弥漫性层间角膜炎的临床分级治疗。方法:收集2008-04/2009-09我院的准分子激光原位角膜磨镶术后弥漫性层间角膜炎患者19例21眼,根据角膜层间炎性细胞浸润程度和浸润范围,制定分级标准,予以相应分级治疗方案。观察其治疗前和治疗后1,3,5,7,10d及1mo时临床症状,角膜浸润程度和范围,视力,屈光度数及眼压等情况。结果:19例21眼准分子激光原位角膜磨镶术后弥漫性层间角膜炎病例多为轻度,其中Ⅰ度18眼,Ⅱ度2眼,Ⅲ度1眼,经过相应分级糖皮质激素治疗,角膜瓣下炎性细胞浸润灶多在1wk内消退,随访至治疗后1mo,裸眼视力显著提高,达术前最佳矫正视力。角膜体征,视力及屈光不正恢复程度在各分级DLK之间,及在接受不同分级治疗方案的病例之间,差异均无统计学意义。无糖皮质激素性高眼压发生。结论:弥漫性层间角膜炎的临床综合分级对糖皮质激素分级治疗准分子激光原位角膜磨镶术后弥漫性层间角膜炎具有治疗指导作用。     

羊膜移植术联合氟康唑治疗真菌性角膜溃疡

目的 研究羊膜移植术联合氟康唑对真菌性角膜溃疡的治疗效果。方法 对临床上确诊的真菌性角膜溃疡13眼，采用羊膜移植术联合氟康唑滴眼及球周注射，术后随访3—12月。结果 术后4—10天炎症控制，11眼角膜溃疡愈合留下不同程度的角膜斑翳，2眼角膜穿孔瘢痕性愈合。结论 羊膜移植术联合氟康唑治疗真菌性角膜溃疡效果显著。     

真菌性角膜溃疡的综合治疗及临床转归

目的：探讨综合疗法治疗真菌性角膜溃疡的效果及临床转归。
　　方法：在我院接受治疗的真菌性角膜溃疡患者共159例159眼,采取10项综合措施治疗,随访3 mo以上,观察溃疡愈合情况及最终视力。
　　结果：真菌性角膜溃疡平均住院时间12.11±5.13d,治愈148例148眼,治愈率93.1%,好转8例(5.0%),无效3例(1.9%)。最终视力≥0.3占56.0%(89/159)。最终视力≥0.1者占85.5%(136/159),在148例治愈患者中占91.9%(136/148)。
　　结论：采取综合疗法治疗真菌性角膜溃疡有较高的治愈率,视力恢复良好。     

Capnocytophaga keratitis

PURPOSE: To review the clinical course, treatment, and visual outcomes of keratitis caused by the gram negative rod CAPNOCYTOPHAGA: DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Ten patients with culture-proven unilateral CAPNOCYTOPHAGA: keratitis examined at the Bascom Palmer Eye Institute between January 1, 1989, and December 31, 1998. INTERVENTION: All patients underwent standard diagnostic microbiologic evaluation, and topical antimicrobial therapy was instituted. A penetrating keratoplasty or enucleation was performed in some patients. MAIN OUTCOME MEASURES: The changes in visual acuity and clinical response to antimicrobial therapy. RESULTS: Predisposing factors were present in all patients. Cultures identified CAPNOCYTOPHAGA: species at a mean of 7.5 days. Initial topical treatment consisted of an aminoglycoside and vancomycin in four patients, a quinolone or aminoglycoside alone in two patients each, and ofloxacin with vancomycin or tobramycin with ceftazidime in one patient each. After the microbiologic identification of CAPNOCYTOPHAGA:, treatment in four patients was changed to intensive, topical clindamycin. Five of the 10 eyes were medically cured (3 of these eyes underwent penetrating keratoplasty for corneal scarring), and 5 eyes required enucleation. The indications for enucleation included persistent infection with development of endophthalmitis or blind, painful eye. Five of the 10 eyes achieved 20/80 or better final visual acuity. Four of these five eyes were treated with topical clindamycin. CONCLUSIONS: Important factors in achieving a good visual outcome in CAPNOCYTOPHAGA: keratitis include early microbiologic identification and intensive therapy with topical clindamycin. CAPNOCYTOPHAGA: should be included in the differential diagnosis of bacterial keratitis in patients with suggestive predisposing factors or with protracted keratitis unresponsive to treatment.     

真菌性角膜炎患者的临床特征及病原菌分布

目的：：分析真菌性角膜炎的临床特征及病原菌的分布,为临床诊疗提供依据。方法：回顾性分析2012-01/2015-07在长江大学附属第一医院诊治的98例98眼真菌性角膜炎患者的临床资料。结果：真菌性角膜炎最主要由植物外伤引起,其次是糖皮质激素的应用及隐形眼镜的不当使用。几乎所有患者出现菌丝苔被、伪足、免疫环、卫星灶等体征,少数患者出现内皮斑和前房积脓。真菌性角膜炎的致病菌主要以镰刀菌属为主(73.5％),其次为曲霉属(13.2％)、念珠菌属(9.2％),其他菌属4.1％。65例65眼患者在选择5％那他霉素滴眼液后治愈,15例15眼患者病情明显好转,其余18例18眼患者病情无明显好转,联合伏立康唑后13例13眼病情好转,5例5眼病情继续恶化,最终3例3眼羊膜遮盖,2例2眼眼球摘除。。结论：真菌性角膜炎在荆州地区的主要流行菌种为镰刀菌。那他霉素眼液可作为临床预防和治疗真菌性角膜炎首选药物。临床医师应加强对真菌性角膜炎的了解,以便早期诊断和及时治疗。     

Evaluation of Intracameral Amphotericin B in the Management of Fungal Keratitis: Randomized Controlled Trial

Purpose: To evaluate the efficacy and safety of intracameral amphotericin B (ICAMB) in the management of fungal keratitis.

Methods: In total, 45 eyes with smear-confirmed fungal keratitis with hypopyon were randomized into three treatment groups: Group I (topical antifungal treatment?+?oral antifungal); Group II (topical antifungal treatment?+?ICAMB?+?oral antifungal); and Group III (topical antifungal treatment?+?drainage of hypopyon?+?ICAMB?+?oral antifungal). The main outcome measures were treatment success rate, time to heal, visual acuity gain, and presence of complications.

Results: There were no differences in the treatment success rates (p?=?0.66), time to healing (p?=?0.18), or mean final visual acuity (logMAR) (p?=?0.8) between the three groups. The major complication observed was increased incidence of cataract in group III (40%), though it was statistically insignificant.

Conclusions: ICAMB does not offer any benefit over topical antifungal therapy when performed alone or associated with drainage of hypopyon.     

Surgical management of fungal endophthalmitis resulting from fungal keratitis

AIM: To report the fungal organisms, clinical features, surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis (EFE) secondary to keratitis, and evaluate the role of surgery in the treatment. METHODS: The clinical records of 27 patients (27 eyes) with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained. RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule, accounting for 56%, 26%, 15% and 2.5%, respectively. Fusarium was identified in 44% (12/27) of the eyes, followed by Aspergillus in 22% (6/27). Posterior segment infection was involved in 78% (21/27) of the patients. The corneal infection was larger than 3 mm ×3 mm in 89% (24/27) of the patients, and 22% (6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes (81.5%) underwent penetrating keratoplasty (PKP), and over half of them (54.5%) were operated within 3d from the onset of antifungal therapy. Fourteen eyes (52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes (55.6%) underwent pars plana vitrectomy (PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60% (9/15), lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes (16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes (18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis. Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy (especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.     

眼局部应用两性霉素B脂质体治疗外伤后真菌性角膜溃疡

目的观察眼局部应用两性霉素B脂质体治疗氟康唑无效的外伤后真菌性角膜溃疡的临床疗效。方法选择外伤后经角膜共焦显微镜及实验室检测确诊为真菌性角膜溃疡（溃疡直径≤5mm）27例（27眼）。其中角膜溃疡13例,角膜溃疡并前房积脓14例。在应用氟康唑治疗无效后应用两性霉素B脂质体滴眼以及前房注药治疗,同时进行常规溃疡面清创、碘酊烧灼治疗,观察其疗效。结果27眼中有22眼达到临床治愈,视力均较术前提高,5眼无效。此5眼中角膜溃疡中有1眼中途放弃治疗,1眼角膜穿孔后行角膜移植;前房积脓者中,1眼中途放弃、1眼行角膜移植;1眼行眼内容物摘除术。结论在早期快速诊断前提下,眼局部使用两性霉素B脂质体是目前治疗外伤后重症真菌性角膜溃疡有效方法之一。     

丝裂霉素C在LASIK术后角膜上皮植入手术治疗中的应用

目的:探讨丝裂霉素C(mitomycin C,MMC)在准分子激光原位角膜磨镶术(laserin situkeratomileusis,LASIK)术后角膜上皮植入手术治疗中应用的临床疗效。方法:在31例31眼LASIK术后角膜上皮植入患者手术治疗中应用0.2g/L MMC,观察术后裸眼视力及角膜瓣愈合情况。结果:术后6mo裸眼视力平均为0.82±0.19,较术前明显提高(P<0.05)。绝大部分患者角膜瓣愈合良好,4例患者角膜瓣边缘部分融解,但中心视力无明显影响。结论:在LASIK术后角膜上皮植入手术治疗中应用0.2g/LMMC可以取得良好的临床疗效。     

视网膜视力计检查在预测白内障术后视力的价值

目的:评价视网膜视力计(retinometer)在预测白内障手术后视力的价值。方法:随机选择各类白内障患者93例106眼,术前采用LAMBDA100视网膜视力计检测患者的预测视力,与术后3mo矫正视力相比较。结果:106眼中12眼(11.3%)术前预测视力与术后视力一致,69眼(65.1%)术后视力好于预测视力(假阴性),25眼(23.6%)术后视力低于预测(假阳性)。结论:视网膜视力计对判断非致密非成熟期白内障的术后视力具有较高的准确性,不同的眼病存在假阴性和假阳性情况,可为术中植入不同类型的人工晶状体提供依据。     

Treatment of fungal keratitis by penetrating keratoplasty

AIM: To study the use of penetrating keratoplasty (PKP) for the treatment of severe fungal keratitis that could not be cured by antifungal medication. METHODS: A retrospective analysis of 108 cases of severe fungal keratitis in which PKP was performed served as the basis for this study. Fungal keratitis was diagnosed by KOH staining of corneal scrapings or by confocal microscopic imaging of the cornea. All patients received a combination of topical and oral antifungal medicines without steroids as the first course of therapy. Patients whose corneal infection was not cured or in whom the infection progressed during antifungal treatment were given a PKP. After surgery, the patients continued to receive antifungal therapy with gradual tapering of the dose over a 1-2 month period. Cyclosporine was used to prevent graft rejection beginning 2 weeks after PKP. Topical steroid only was administered to the patient whose donor graft was over 8.5 mm and with a heavy iris inflammation 2 weeks after PKP. The surgical specimens were used for microbiological evaluation and examined histopathologically. The patients were followed for 6-24 months after PKP. Graft rejection, clarity of the graft, visual acuity, and surgical complications were recorded. RESULTS: Corneal grafts in 86 eyes (79.6%) remained clear during follow up. There was no recurrence of fungal infection and the visual acuity ranged from 40/200 to 20/20. Complications in some patients included recurrent fungal infection in eight eyes (7.4%), corneal graft rejection in 32 eyes (29.6%), secondary glaucoma in two eyes (1.9%), and five eyes (4.6%) developed cataracts. 98 of 108 of the recipient corneas had PAS positive fungal hyphae in tissue sections; 97 of 108 were culture positive for various fungi, including Fusarium (63), Aspergillus (14), Candida (9), Penicillium (4), and seven cases in which septate hyphae were seen but identification of the organism was not conclusive. CONCLUSIONS: PKP is an effective treatment for fungal keratitis that does not respond to antifungal medication. Early surgical intervention before the disease becomes advanced is recommended. It is critical that the surgical procedure remove the infected tissue in its entirety in order to effect a cure.     

LASEK与去瓣LASEK手术临床观察

目的:对比观察常规保留上皮瓣LASEK和去瓣LASEK治疗近视术后的临床表现,评估去瓣LASEK手术的安全性和有效性。方法:采用自身对照法观察57例114眼近视患者,左眼采用去瓣LASEK(制作活性上皮瓣)作为观察组,右眼采用常规保留上皮瓣LASEK作为对照组,随访6mo,观察术后1～3d两眼的疼痛反应、视力恢复情况以及6mo内haze的变化情况。结果:两种方法均取得较好的手术效果,去瓣LASEK组术后1～3d内疼痛反应级别无不适和轻度有54眼占本组94.7%,中度反应3眼占5.3%,常规LASEK手术组术后1～3d内疼痛反应无不适有6眼占本组10.5%,轻度38眼和中度13眼共占89.5%,两组均未出现重度疼痛;术后视力恢复:术后第1d和第5d去除上皮瓣LASEK组分别是0.8和0.86,常规LASEK组分别是0.69和0.76,术后2wk后两组视力无明显差异;术后6mo内haze情况两组无明显差异。结论:通过对两组结果对比和分析,去瓣LASEK术相对常规保留上皮瓣LASEK手术术后反应较轻,视力恢复较快,有较好的安全性和可预测性。