丝状角膜炎的共聚焦显微镜观察

目的：应用活体激光共聚焦显微镜（ IVCM）观察丝状角膜炎患者丝状物的组成结构及位置特点,分析角膜丝状物的形成机制。方法收集深圳市眼科医院2014年6月至2016年1月收治的丝状角膜炎患者48例（60只眼）,详细记录患者的病史和相关检查。采用共焦显微镜观察角膜丝状物的组成结构和角膜丝状物附着处的角膜结构。结果活体激光共聚焦显微镜检查显示,丝状物起自前弹力层,由上皮细胞、炎性细胞、黏液、螺旋状条形核心构成,核心结构中亦含有上皮细胞、炎性细胞及纤维状组织。结论丝状角膜炎丝状物的共聚焦表现特点可以为临床治疗方法的选择提供影像的参考依据。     

放射状角膜切开术后丝状角膜炎的治疗

放射状角膜切开术后丝状角膜炎的治疗第一军医大学南方医院眼科汤明芳，黄发明随着放射状角膜切开术（简称ＲＫ术）的逐渐推广，术后并发症亦引起了重视．ＲＫ术后出现丝状角膜炎在国内为首次报道．从９３年５月至９５年５月我院共做５０３例ＲＫ手术．术后１５例１８只眼...     

中西医治疗单疮病毒性角膜炎

中西医治疗单疮病毒性角膜炎浙江临安锦城医院眼科（３１１３００）叶美姣单疮病毒性角膜炎，笔者应用中药内服结合西药滴眼治疗单疮病毒性角膜炎（ＨＳＫ）收到满意疗效，现报告如下：临床资料１一般资料：共２３例２６眼，右眼１１只，左眼１５只。男性１８例，女性５例...     

一叶萩碱（SCRN）抗Ⅰ型单纯疱疹病毒眼部感染的临床研究

一叶萩碱（ＳＣＲＮ）为中草药一叶的主要生物碱。在体外细胞培养及动物实验证实ＳＣＲＮ具有明显的抗Ⅰ型单纯疱疹病毒（ＨＳＶ－１）活性的作用基础上，本文应用０．１％ＳＣＲＮ点眼剂及０．１％无环鸟苷点眼剂治疗临床单疱病毒角膜炎患者５８例（６７眼），进行疗效对比观察，同时对患者治疗前后泪液中ＳＩｇＡ及锌离子含量的变化进行了动态检测。结果表明ＳＣＲＮ点眼剂治疗ＨＳＫ患者具有显著的疗效，尤其在治疗浅层型ＨＳＫ及降低复发率方面更为突出。经过ＳＣＲＮ治疗的患者泪液中ＳＩｇＡ及锌离子水平显著提高，接近正常水平；作者阐明、分析了ＳＣＲＮ治疗ＨＳＫ的作用机制。     

珍珠退翳散治疗卷丝状角膜炎

珍珠退翳散治疗卷丝状角膜炎江苏省扬州市广陵医院（２２５００１）王新生卷丝状角膜炎是以角膜表面出现大小不等的上皮卷丝为特征的一种角膜病变，自１９９２年～１９９４年，笔者用珍珠退翳散治疗２４例，获得满意效果，现报告如下。临床资料１对象：２４例３５只眼，均...     

素高捷疗眼膏治疗丝状角膜炎临床观察

素高捷疗眼膏治疗丝状角膜炎临床观察江苏无锡市北塘医院眼科董万国近年来，素高捷疗眼膏（ＳｏｌｃｏｓｅｒｙＥｙｅ—Ｇｅｌ瑞士产）被广泛应用于角膜病的治疗［１，２］。但使用该药治疗丝状角膜炎的报告少见。我科对８例丝状角膜炎单独采用录高捷疗眼膏治疗，取得满意...     

单疱病毒性角膜炎的新分型及其治疗

目的评价Holland等提出的单疱病毒性角膜炎（HSK）新分类法在诊治HSK时的指导意义及皮质类固醇类药物在治疗HSK时的作用。方法在临床诊治的73例（92眼）HSK患者时应用Holland等提出的新分类法进行分类，再根据不同类型的HSK在抗病毒治疗的基础上灵活应用皮质类固醇类药物进行治疗，观察其临床疗效。结果本组73例（92眼）HSK患者中，感染性角膜上皮炎型42眼，均治愈。基质型角膜炎34眼中，26眼免疫性基质型角膜炎均治愈。3眼坏死性角膜基质炎药物治疗无效行穿透性角膜移植2眼，行深板层角膜移植术1眼。内皮型角膜炎16眼，均治愈。结论Holland等提出的HSK新分类法在临床诊治HSK时具有很好的指导作用，灵活巧妙应用皮质类固醇类药物在治疗HSK时能收到满意的治疗效果。     

PCR对单疱病毒性角膜炎的诊断

应用聚合酶链反应（ＰＣＲ）技术对临床诊断活动期ＨＳＫ３０眼，匐行性角膜溃疡５眼，原因未明角膜炎３眼进行ＨＳＶ－１ＤＮＡ检测，选择ＨＳＶ的胸苷激酶（ＴＫ）基因为目的基因，扩增片段为１１０ｂｐ。ＰＣＲ法检测同时将上述标本进行组织培养。３０眼活动期ＨＳＫ角膜上皮标本２８眼检出ＨＳＶ－１ＤＮＡ，组织培养阳性９眼；５眼匐行性角膜溃疡全部未测出ＨＳＶＩＤＮＡ；３眼原因未明角膜炎中１眼检出ＨＳＶ－１ＤＮＡ，组织培养均为阴性。结果表明：ＰＣＲ法可用于ＨＳＫ的病原学诊断，其特异性强，灵敏度高，适于临床标本的快速检测，尤其对于临床没有典型病变，角膜炎不能定性者价值更高。     

双黄连粉针超声雾化眼浴法治疗角膜病

目的：观察应用双黄连粉针超声雾化眼浴法治疗角膜病的疗效。方法：对130例（202只眼）角膜病变患者,其中单纯疱疹性角膜炎48例,腺病毒性角膜炎40例,春季卡他性角膜炎30例,带状疱疹性角膜炎12例,采用双黄连粉针为主药超声雾化眼浴法进行临床治疗观察。结果：治愈115只眼;好转78只眼,无效9只眼,总有效率为95．5％。结论：双黄连粉针超声雾化眼浴法治疗角膜病变有效,是眼部治疗给药新方法的尝试。     

眼轴长度与角膜屈光力对准分子激光屈光性角膜切削术疗效的影响

目的 探讨眼轴长度、角膜屈光力对准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅ ｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）疗效的影响。方法 应用美国Ｋｅｒａｃｏｒ－１１７型准分子激光仪对８０例（１２１只眼）近视患者进行治疗。按眼轴（ａｘａｉｌ ｅｇｎｔｈ,ＡＬ）及角膜屈光力（ｋｅｒａｔｏｍｅｔｒｉｃ ｖａｌｕｅ,ＫＶ）进行分组：１组４９只眼,ＡＬ〉２６ｍｍ,ＫＶ≤４５Ｄ;２组３６只眼,ＡＬ≤２６     

角膜屈光术不同制瓣方式术后丝状角膜炎研究

目的 观察角膜屈光手术不同制瓣方式术后丝状角膜炎的发病情况,探讨其发病的相关因素及防治方法.方法 回顾性临床病例对照研究.对2004年7月至2010年7月在厦门大学附属厦门眼科中心就诊的14 360例28 702只眼近视伴散光者行角膜屈光手术,其中11 542例(23 082只眼)行微型自动旋转式角膜板层刀(LASIK组)制瓣,516例(1 030只眼)行飞秒激光Femto-second laser(FS组)制瓣,2 302例(4 590只眼)行LASEK治疗,观察三组术后丝状角膜炎的发生情况,比较其发病率,发病者均予以及时去除丝状物及配戴日抛型角膜接触镜治疗.结果 LASIK组、FS组及LASEK组丝状角膜炎发病率分别为0.16%、0%、1.35%,三者差异有统计学意义(X2=-152.642,P＜0.05).所有丝状角膜炎患者经过1-4 d的治疗,均得到痊愈,无1例复发.结论 飞秒激光制瓣比常规角膜板层刀及乙醇制瓣术后丝状角膜炎发病率低,采用去除丝状物、应用人工泪液联合配戴日抛型角膜接触镜等方法,可有效治疗术后丝状角膜炎.

Abstract：

Objective To compare the incidence, underlying pathophysiology, and clinical features of filamentary keratitis in different flap preparation styles of excimer laser surgery. Methods It was a retrospective case-control study. All 28702 eyes were divided into group A including 23082eyes treated with laser-assisted in situ keratomileusis in Xiamen Eye Center of Xiamen University between July 2004 and July 2010 with 90 m microkeratome flap preparation, group B of 1030 eyes treated with laser-assisted in situ keratomileusis with 100 m femoto-second laser flap preparation and group C of 4590 eyes treated with laser epithelial keratomileusis. The incidences of the postoperative filamentary keratitis were observed and compared. In cases suffered with filamentary keratitis changes in corneal signs by slitlamp evaluation, appropriate artificial tears therapy and therapeutic lens treatment were required. Results The incidences were significantly different (P ＜0.05) between group A, group B and group C with 0.16%, 0 and 1.35% respectively, and all cases suffered with filamentary keratitis had complete healing. No additional complications were reported. Conclusions The incidence of filamentary keratitis after excimer laser corneal refractive surgery is affected by the different flap preparation styles. The removement of filaments and the use of artificial tears and soft contact lenses for therapeutic purposes are safe, effective and practical.     

Results of Therapeutic Penetrating Keratoplasty

Purpose By a retrospective study of patients in the Ankara Hospital Eye Clinic, to determine the anatomical and visual results of therapeutic penetrating keratoplasty (PK) and its role in the management of corneal disease.Methods Therapeutic PK was performed in 36 patients (37 eyes) who had corneal perforation due to corneal disease (23 eyes) or eyes in which perforation was imminent (14 eyes). Initial indications for grafting were nonperforated descemetocele without inflammation (six eyes, 16.2%); nonperforated bacterial corneal ulcer (five eyes, 13.5%); nonperforated herpetic keratitis with active stromal inflammation (two eyes, 5.4%); acanthamoeba keratitis (one eye, 2.7%); perforation due to herpetic keratitis (13 eyes, 35.2%); perforation due to persistent epithelial defect (8 eyes, 21.6%); or perforation due to bacterial corneal ulcer (two eyes; 5.4%). The results were evaluated for each of the following criteria: anatomical integrity of the eye, cure of the disease, complications, graft clarity, and visual acuity.Results Anatomical integrity was achieved in 21 of the 23 eyes (91.3%) perforated from corneal disease. Therapeutic PK cured the disease in all bacterial keratitis cases. The proportion of clear grafts was 60.9% in the 23 eyes perforated from corneal disease, and 57.1% in the 14 eyes in which perforation was imminent. Fifteen eyes (40.5%) obtained a final visual acuity of 20/100 or better; five of these eyes were not yet perforated before the PK.Conclusions Therapeutic PK is effective in the management of the eye with active uncontrolled infection or perforation from corneal disease. Approximately half of our patients maintained a clear graft at the last visit. Without therapeutic surgery, these eyes would have been lost. Jpn J Ophthalmol 2004;48:368–371 © Japanese Ophthalmological Society 2004     

贝复舒在治疗真菌性角膜溃疡中的应用

目的观祭治疗具酉性角膜溃疡中应用贝复舒的效果。方法真菌性角膜溃疡患者100例100眼随机分戍治疗组70眼和对照组30眼，治疗组应用贝复舒，对照组应用角膜宁，疗程10d。对比观察2组角膜创面愈合与角膜缘血管翳形成情况。结果治疗组局部创面1周内全部愈合，术后6月3眼形成角膜缘血管翳；对照组1周内22眼愈合，术后6月20眼形成角膜缘血管翳。2者比较差异显著（P〈0．01）。结论贝复舒在治疗真菌性角膜溃疡中具有显著效果。[眼科新进展2005；25（5）：454—455]     

Aspergillus Keratitis with Intraocular Invasion

A healthy 48-year-old man developed Aspergillus keratitis following mild corneal trauma. Intensive medical therapy, initially empirical, then guided by in vitro sensitivity testing, as well as attempts at surgical excision of the infection, were ultimately nsuccessful. The poor therapeutic response may have been due to fungal penetration of the deep corneal stromal before treatment was initiated. The clinical and histologic features of A keratitis are described and related to fungal keratitis in general. The strengths and limitations of laboratory diagnostic aids are discussed. Fungal keratitis may follow a disarmingly mild early clinical course, but requires prompt, aggressive therapy if serious complications are to be avoided.     

真菌性角膜炎手术治疗的探讨

目的　探讨真菌性角膜炎的手术疗效。方法　真菌性角膜炎 63例 (63眼 )。 5 6眼施行常规穿透性角膜移植术 ,7眼施行眼前段重建术。术后随访 3～ 19月 ,观察病变转归及手术疗效。结果　术后 41眼角膜移植片保持透明 ;15眼移植片浑浊 ,其中有 7眼发生排斥反应。真菌性角膜炎复发 7眼 ,其中 3眼施行眼内容摘除术。结论　穿透性角膜移植术和眼前段重建术是治疗真菌性角膜炎比较有效的方法。     

1g/L氟米龙滴眼液联合软性角膜接触镜治疗丝状角膜炎

目的：探讨1g/L氟米龙滴眼液联合软性角膜接触镜治疗丝状角膜炎的疗效。

方法：确诊丝状角膜炎患者30例45眼,随机分为治疗组16例23眼、对照组14例22眼。治疗组取出丝状物后配戴软性角膜接触镜,点糖皮质激素眼液(1g/L氟米龙滴眼液)和人工泪液(玻璃酸钠眼液); 对照组取出丝状物后仅使用人工泪液(玻璃酸钠眼液)点眼。随访3mo,比较两组疗效。

结果：治疗组患者临床治疗总有效率22眼(96%),明显高于对照组17眼(77%),差异有统计学意义(P=0.046),且发现未对眼压有明显影响。

结论：1g/L氟米龙联合软性角膜接触镜治疗丝状角膜炎有较好疗效。     

Antifungal chemotherapy for fungal keratitis guided by in vivo confocal microscopy

Background To evaluate antifungal chemotherapy in patients with fungal keratitis guided by in vivo confocal microscopy. Methods A total of 121 patients (121 eyes) with fungal keratitis were enrolled in this study. Confocal microscopy was performed in real time after topical and/or oral antifungal chemotherapy. Hyphal density and morphology, composition of inflammatory cells, and appearance of corneal stromal cells at the central and peripheral corneal lesions were recorded. Antifungal therapy discontinued at 1 week after hyphae and inflammatory cells could not be detected, and affected corneal stromal cells became visible. Results Successful outcomes were achieved in 110 patients (90.9%). By confocal microscopy, we observed the gradual decrease of hyphae-positive sites and hyphal density during the chemotherapy. The inflammatory cells reduced in number and heterogeneity, while corneal stromal cells recovered. The antifungal drugs were tapered according to the changes in hyphae, inflammatory cells, and corneal stromal cells. There was no fungal recurrence during the 2-month follow-up period. The other 11 patients (9.1%) had deteriorated infection within 1 week of antifungal therapy, and therefore were subjected to corneal transplantation. Conclusions In vivo confocal microscopy appears to be an effective approach to guide antifungal chemotherapy. It allows comprehensive evaluation of hyphae, inflammatory cells, and corneal stromal cells in real time, and provides valuable and objective information required in selecting and adjusting therapeutic regimens for the treatment of fungal keratitis.     

角膜胶原交联治疗真菌性角膜溃疡的临床疗效

目的：探讨角膜胶原交联术在治疗真菌性角膜溃疡的可行性及临床疗效。方法：回顾性系列病例研究。收集2011年11月至2017年12月于厦门大学附属厦门眼科中心住院治疗的真菌性角膜溃疡患者82例（82眼）,在联合用药无效或效果不佳的情况下行角膜胶原交联术。术后观察指标包括患者的主观症状、角膜溃疡愈合情况、视力恢复情况,共聚焦显微镜检查角膜溃疡情况。结果：所有患者术后观察时间为6个月至3年,角膜溃疡逐渐愈合形成不同程度瘢痕71例（愈合率87%）,其中视力提高且不需要再次手术患者52例;病情仍然进一步加重,急性期行角膜移植手术患者8例,急性期行自体结膜瓣遮盖术患者1例;溃疡稳定但再次复发加重并行角膜移植术患者2例。结论：角膜胶原交联术是真菌性角膜溃疡新的治疗方法,且其联合药物治疗真菌性角膜溃疡简单、安全、有效。     

Collagen Cross-Linking for the Treatment of Fungal Keratitis

Objective: To evaluate whether corneal collagen cross-linking improves the outcome of fungal keratitis. Methods: This was a retrospective clinical study. Patients (n=82) with fungal infected eyes were treated at Affiliated Xiamen Eye Center of Xiamen University, from November 2011 to December 2017. Corneal cross-linking was performed using the standard protocol after a multi-antifungal drug treatment failed to resolve the infection in patients. Main outcome measures: Clinical symptoms and corneal healing were examined using a slit lamp biomicroscope and an in vivo laser confocal microscope. Visual acuity improvement was also evaluated. Results: After 6 months to 3 years of follow-up, corneal scars eventually developed in 71 of 82 eyes. In 52 of 82 eyes, visual acuity improved. However, corneal melting was exacerbated and uncontrolled in 8 patients who immediately underwent corneal transplant surgery. In one patient, self-conjunctival transplantation was performed, and two others received a therapeutic corneal transplant due to recurrent inflammation and melting. Conclusions: Our results demonstrate that corneal collagen cross-linking is an effective procedure to manage patients afflicted with fungal keratitis.     

Pythium keratitis: Clinical profile,laboratory diagnosis,treatment, and histopathology features post-treatment at a tertiary eye care center in Eastern India

Purpose:The aim of this work was to study demography, clinical profile, laboratory diagnosis, and management of Pythium keratitis at a tertiary eye care center in Eastern India.Methods:Eighteen patients with culture-positive Pythium keratitis managed at our center between January 2016 and December 2018 were included in this retrospective study. Clinical features, laboratory investigations, treatment, and outcomes were analysed.Results:Pythium keratitis commonly affects middle-aged males with low socioeconomic profile and history of trauma. Samples stained with Gomori methenamine silver showed 93.8% positivity and Iodine-potassium iodide-sulfuric acid showed 100% positivity. Periodic acid-Schiff''s showed negative staining in 62.5% and weak in 37.5%. Kirby-Bauer disc diffusion method showed zone of inhibition as 30.25 ± 4.61 mm for Linezolid and 23.56 ± 6.86 mm for Azithromycin. Medical management included topical/oral linezolid and azithromycin. Therapeutic penetrating keratoplasty (TPK) was done in 15 eyes (83.3%), repeat TPK in 4 eyes, and evisceration in 3 eyes (16.7%). One patient required only medical treatment. Globe salvation was obtained in 15 (83.3%) eyes, and good visual outcome in 7 eyes (38. 9%). There was graft failure in six eyes (40%) and two (11.1%) eyes went into phthisis. Patients were divided into early and late presenters. Late presenters had more complications and worse final visual outcome.Conclusion:Pythium keratitis can be differentiated from fungal keratitis by its characteristic appearance on slit-lamp examination, smear, culture, and histopathology. Early presentation, detection, and treatment with antibacterial drugs like linezolid and azithromycin results in a better prognosis. Early full-thickness corneal transplant should be considered for Pythium keratitis not responding to treatment.