氢氧化钾涂片镜检法诊断真菌性角膜炎的应用

目的探讨氢氧化钾（KOH）涂片镜检法对真菌性角膜炎的诊断价值,了解真菌性角膜炎的病原学特征。方法取58例真菌性角膜炎患者的角膜溃疡标本,作KOH涂片镜检、真菌培养及菌种鉴定。结果 KOH涂片镜检法和真菌培养法的阳性率分别为58.62%（17/29）、52.94%（9/17）,两者的真菌检出率差异无统计学意义（P〉0.05）。9份培养阳性标本中,共分离出3属3种真菌,其中镰刀菌属、暗色孢科真菌、酵母菌分别占35.29%、11.76%、5.88%。结论 KOH涂片镜检法是早期诊断本病的简单、有效方法,镰刀菌和暗色孢科真菌是宁夏地区真菌性角膜炎的主要致病菌。     

广东湛江地区真菌性角膜炎病原菌的分离鉴定和分析

目的了解广东湛江地区引起真菌性角膜炎的病原真菌的分布情况. 方法对70例疑患真菌性角膜炎的患者,取病变角膜上皮组织,分别进行真菌直接涂片镜检和真菌培养,并对检查阳性者进行菌种鉴定. 结果70例病眼患者均检出真菌,涂片镜检真菌阳性67份,阳性率为95.7%,真菌培养阳性65份,阳性率92.9%,总一致性为89.6%.检出菌种分属14个属26个种,其中镰刀菌属22株（33.8%）,弯孢霉属20株（30.8%）、曲霉属4株（6.2%）,球孢子菌属4株（6.2%）,其他菌属15株（23.1%）. 结论北热带的广东湛江地区真菌性角膜炎主要致病菌属为镰刀菌属和弯孢霉属,主要菌种以新月弯孢霉最多见.     

Pathogenic analysis of fungal keratitis: a report of 94 cases.

目的 了解海南地区真菌性角膜炎病原菌的种类和构成情况,分析真菌性角膜炎患者的流行病学特征,并指导临床个体化治疗.方法 对2010年3月至2011年2月在我院眼科门诊就诊的94例刮片镜检阳性的真菌性角膜炎患者的病例进行回顾性分析,细菌培养鉴定菌种.结果 海南地区真菌性角膜炎在10～12月份为高发季节,以镰刀菌感染(61例,64.9％)为主,除此之外还有烟曲霉菌(28例,29.8％)、链格孢霉菌(2例,2.1％)、待鉴定菌种(3例,3.2％).结论 真菌性角膜炎是严重的致盲性眼病,应提高对该病的认识和诊断水平,镰刀菌为目前海南地区真菌性角膜炎的主要致病菌.     

真菌性角膜炎病原菌的流行病学调查

目的 了解真菌性角膜炎病原菌的种类和构成情况，获取流行病学资料，并指导临床个体化治疗。方法 对2001年1月至2005年12月在我院就诊明确诊断真菌性角膜炎的病例进行回顾性分析。结果 共有239例真菌性角膜炎，共培养出真菌菌株156株，其中以镰刀菌感染（77例，49．36％）和曲霉菌感染（52例，33．33％）为主，除此之外还有白色念珠菌感染（18例，11．54％），青霉菌感染（7例，4．49％），头孢霉菌感染（2例，1．28％）。结论 镰刀菌仍为目前青岛地区真菌性角膜炎的主要致病菌，但其所占比例逐年下降，曲霉菌在致病菌中的比例逐年升高。     

KOH湿片镜检法与CFW荧光染色法诊断真菌性角膜炎的效果比较

目的:探求早期、快速和准确诊断真菌性角膜炎的实验室方法.方法:对58例真菌培养阳性的真菌性角膜炎患者的角膜刮片进行涂片镜检,同一涂片先行KOH湿片镜检,然后行Calcofluor White(CFW)荧光染色镜检.以真菌培养阳性为诊断真菌性角膜炎的金标准,对检查结果进行对比分析.结果:同一涂片KOH湿片阳性率为81.0%(47/58),而CFW荧光染色阳性率为96.6%(56/58).2者共阳性47例.共阴性2例,CFW荧光染色阳性率高于KOH湿片镜检法(χ2=7.11,P<0.001).结论:角膜刮片CFW荧光染色镜检诊断真菌性角膜炎优于KOH湿片镜检.     

真菌性角膜炎的实验室快速诊断方法分析

目的:探讨真菌性角膜炎快速而有效的临床实验室诊断方法。方法:对2012年6-12月53例临床疑似真菌性角膜炎患者送检的角膜刮片标本,同时进行墨汁-KOH湿片法镜检、荧光染色镜检和真菌培养。以真菌培养为诊断金标准,对墨汁-KOH湿片法与荧光染色法进行方法学比较。结果:32例真菌培养阳性标本,墨汁-KOH湿片法20例阳性,阳性率为62.5%,荧光染色28例阳性,阳性率为87.5%,两者阳性率比较差异有统计学意义(字2=6.125,P=0.025);两种涂片镜检共为阳性的20例,共为阴性的4例。结论:荧光染色法镜检可以提高真菌性角膜炎的阳性诊断率,是真菌性角膜炎快速、简单、有效的临床实验室诊断方法。     

3种常见菌属真菌性角膜炎的临床特征及相关特点分析

目的：：分析镰刀菌属、曲霉菌属和链格孢霉属3种常见菌属导致的真菌性角膜炎( FK)的临床特征及其致病危险因素等相关特点,旨在为真菌性角膜炎的临床诊治提供依据。方法：回顾性分析我院2011年6月~2014年6月收治的10例因3种常见菌属感染所致的真菌性角膜炎患者的临床资料,对其易感人群特点、感染危险因素、感染临床特征、治疗方法及并发症发生情况等特点进行分析。结果：3种常见菌属感染所致的真菌性角膜炎患者的主要临床表现有伪足(7例)、前房积浓(4例)、卫星灶(3例)、苔被(2例)、内皮斑(1例)和免疫环(1例)。镰刀菌属的感染灶面积为18.22±15.37mm2,曲霉菌属为14.59±14.62mm2,链格孢霉属为16.32±32.78mm2,3种菌属的感染面积比较差异无统计学意义(P>0.05);主要并发症有合并细菌感染(其中镰刀菌属1例,曲霉菌属1例)、合并角膜穿孔(其中镰刀菌属1例,曲霉菌属1例)、合并继发性青光眼(其中镰刀菌属3例,曲霉菌属2例,链格孢霉属1例)。结论：镰刀菌属与曲霉菌属所致FK的病情进展快,其中镰刀菌属感染面积较大,主要有伪足和卫星灶等临床表现,曲霉菌属主要表现为前房积脓、苔被、内皮斑和伪足,链格孢霉属主要表现为伪足、前房积脓和卫星灶。研究3种感染菌属的临床特征有助于早期明确诊断和及时给予针对性治疗。     

激光共焦显微镜检查与KOH湿片镜检法诊断真菌性角膜炎的比较研究

目的：分析激光共焦显微镜检查与KOH湿片镜检法在诊断真菌性角膜炎的应用效果,探讨早期、快速、准确诊断真菌性角膜炎的诊断方法。方法：选择拟诊断真菌性角膜炎患者168例为研究对象,分别进行激光共焦显微镜检查与KOH湿片镜检,以真菌培养阳性为诊断真菌性角膜炎的金标准,观察图像特点,比较诊断结果。结果：168份真菌性角膜炎标本中,真菌培养阳性158份,阴性10份。激光共焦检出阳性148例,阴性8例;KOH湿片镜检检出阳性121例,阴性7例。激光共焦显微镜检查灵敏度、准确度、阴性预测均明显高于KOH湿片镜检,差异具有统计学意义（P〈0.05）;激光共焦镜下显示,不同菌丝长度、直径、荧光含量、菌丝密度、炎性细胞密度比较,差异有统计学意义（P〈0.05）,菌丝密度与炎性细胞密度呈负相关性。结论：激光共焦显微镜检查能够提高真菌性角膜炎早期诊断水平,KOH作为辅助检测方法对提高准确诊断率有积极意义。     

真菌性角膜炎致病菌分布、耐药性及预后不良因素分析

目的 分析真菌性角膜炎病原菌分布、耐药性特点，同时探讨影响其患者预后的主要因素，从而为真菌性角膜炎的防治提供临床依据。方法 回顾性分析2010年6月~2015年6月在笔者医院诊治的195例真菌性角膜炎患者临床资料，分析其病原菌分布、耐药性特点及相关影响预后的主要危险因素。结果 195例眼部标本中，真菌培养阳性152例（77.9%）。主要的致病真菌属为镰刀菌属75例（49.3%），曲霉属35例（23.0%），链格孢属23例（15.1%）。常见真菌对那他霉素敏感度最高，总敏感度达到89.5%，对氟康唑敏感度最低，总敏感度62.4%。Logistic回归分析显示，白蛋白水平<35g/L、患病天数≥14天、病灶情况分级为Ⅲ~Ⅳ级及上皮修复时间≥21天为影响真菌性角膜炎患者预后的独立危险因素。结论 镰刀菌属是本地区主要的真菌性角膜炎致病菌属，其对两性霉素B敏感度最高，临床上应根据病原菌分布、药敏试验结果及影响预后的相关危险因素，合理选用抗生素，同时积极采取综合防治措施，改善患者的临床疗效及预后。     

94例真菌性角膜炎患者的病原菌临床分析

目的了解海南地区真菌性角膜炎病原菌的种类和构成情况,分析真菌性角膜炎患者的流行病学特征,并指导临床个体化治疗。方法对2010年3月至2011年2月在我院眼科门诊就诊的94例刮片镜检阳性的真菌性角膜炎患者的病例进行回顾性分析,细菌培养鉴定菌种。结果海南地区真菌性角膜炎在10~12月份为高发季节,以镰刀菌感染(61例,64.9%)为主,除此之外还有烟曲霉菌(28例,29.8%)、链格孢霉菌(2例,2.1%)、待鉴定菌种(3例,3.2%)。结论真菌性角膜炎是严重的致盲性眼病,应提高对该病的认识和诊断水平,镰刀菌为目前海南地区真菌性角膜炎的主要致病菌。     

棘阿米巴角膜炎的实验室诊断及实验研究

目的 :找出快速诊断和鉴定棘阿米巴角膜炎的方法 ,建立棘阿米巴角膜炎的动物模型。方法 :10 %氢氧化钾 (KOH)湿封片镜检、棘阿米巴原虫培养、倒置显微镜观察、病理切片作HE染色和PAS染色检查。通过家兔应用激素 3天后 ,经角膜基质内注射棘阿米巴原虫悬液。结果 :角膜刮片及手术切除的角膜材料 ,经 10 %氢氧化钾 (KOH)湿封片镜检 ,前者查到 8例棘阿米巴角膜炎病例 ,后者确诊 5例 ;手术切除的角膜材料经原虫培养 ,分离出 6株棘阿米巴原虫 ;应用倒置显微镜直接观察 ,见到棘阿米巴原虫的包囊、滋养体和棘刺。建立了家兔棘阿米巴角膜炎动物模型。结论 :应用 10 %KOH湿封片镜检以及通过倒置显微镜直接观察培养的原虫可对棘阿米巴角膜炎作快速诊断 ;倒置显微镜可直接观察和鉴定棘阿米巴原虫 ,方法简便、不污染、快速 ;家兔棘阿米巴角膜炎的动物模型建成快速及实用     

Role of potassium hydroxide mount in rapid diagnosis of fungal corneal ulcers

The aim of the study was to establish the importance of KOH mount in rapid diagnosis of fungal corneal ulcers. Corneal scrapings were collected from 50 patients with corneal ulcers where clinical features suggested fungal aetiology and ulcers showed no signs of healing on initial treatment. Corneal scrapings were subjected to wet mount with 10% KOH, Gram's stain, and culture on SDA media. Wet mount showed fungal elements in 34 cases (68%) and were classified according to morphology. Gram's stain of corneal scrapings did not provide much help. Fungal culture was positive in 9 (26.4%) out of 34 cases. Specific antifungal treatment was instituted in all cases that showed positive wet mount without waiting for culture reports and on follow-up all these 34 patients showed improvement. Thus wet mount with 10% KOH can be relied upon as the singlemost important screening tool for rapid diagnosis of fungal corneal ulcer and treatment should be dispensed on its basis.     

深板层角膜移植术治疗坏死性角膜基质炎

目的：评价深板层角膜移植治疗坏死性角膜基质炎的临床效果及影响因素。方法：采用深板层角膜移植治疗坏死性角膜基质炎21例（21眼）,临床观察3～23个月。结果：术后矫正视力≥0.3者19眼（90.48%）,发生排斥反应3眼（14.29%）,复发1例（4.76%）。植片透明21眼,透明率为100%。结论：深板层角膜移植术具有清除病灶彻底、排斥反应发生率低、无内眼手术并发症等优点,是治疗坏死性角膜基质炎的理想方法。     

146例穿透性角膜移植的临床研究

目的探讨穿透性角膜移植的主要病因、疗效及并发症.方法对146例(158眼)穿透性角膜移植(PKP)进行回顾性研究,随访0.5～7.5年.结果病因:单纯疱疹病毒性角膜炎112眼(70.9%),角膜白斑18眼(11.4%),细菌性角膜炎11眼(7.0%),圆锥角膜8眼(5.0%),其他9眼(5.7%).疗效:植片透明140眼;视力:0.05以下6眼(4.0%),0.05～0.2,30眼(19%),0.25～0.5,82眼(52%),0.6以上40眼(25%);并发症:主要并发症是免疫排斥反应6例(4.0%),12例单纯疱疹病毒性角膜炎复发.结论穿透性角膜移植是治疗角膜疾病的有效方法.     

我国真菌性角膜病高发区致病真菌种类调查

目的：了解我国真菌性角膜病高发区的致病真菌种类以及致病菌种在各地区间的差异。方法：对我国华中的郑州地区、华北的石家庄地区以及华南的广州地区１９７５年１月至１９９７年６月间６１５例真菌性角膜炎患者的致病菌进行分析并分类到种。结果：６１５例菌分为１８属４７种。华北及华中地区的主要致病菌属基本相同，依次为镰孢菌属、曲霉属、青霉属，但主要致病菌种两地区略有差异。广州地区１９７５年１月至１９８６年１２月的资料显示主要致病菌依次为曲霉属、镰孢菌属、青霉属，近８年则依次为镰抱菌属、曲霉属、弯孢霉属。结论：我国真菌性角膜炎的首位致病菌为镰抱菌属。     

Microbial keratitis: aetiological diagnosis and clinical features in patients admitted to Hospital Universiti Sains Malaysia

INTRODUCTION: Corneal ulceration remains one of the major causes of blindness in developing countries, including Malaysia. Our objective is to determine the epidemiological characteristics, clinical features, risk factors and the aetiology of microbial keratitis in patients admitted to Hospital Universiti Sains Malaysia (HUSM). METHODS: All patients with microbial keratitis admitted to our hospital over a 16-month period from January 2004 to April 2005 were included in the study. Sociodemographic data and information pertaining to risk factors were recorded. All patients underwent examination with slit lamp biomicroscopy and corneal scrapings were sent for microbiological diagnosis. RESULTS: 42 patients were included in the study; 26 were male and 16 were female, with mean age of 44.5 (+/- 20.9) years. History of previous corneal trauma was present in 26 (61.9 percent) patients. Central location ulcers were more predominant (69 percent) than peripheral ulcers. Cultures from corneal scrapings were positive in 29 cases (69 percent). Of those individuals with positive cultures, 23 (79.3 percent) had pure bacterial infection, four (13.8 percent) had pure fungal infection and two (6.9 percent) had mixed growth. The most common bacterial pathogen isolated was Pseudomonas aeruginosa (40.5 percent), followed by Streptococcus pneumoniae (7.5 percent). Fungal pathogens which were isolated include Fusarium spp. (4.7 percent) and Aspergillus spp. (2.4 percent). CONCLUSION: Central corneal ulceration is a problem among patients presenting with microbial keratitis in HUSM. It often occurs after corneal trauma. These findings have important public health implications for the treatment and prevention of visual morbidity due to an infective cause.     

Changing indications for lamellar keratoplasty in Shandong, 1993–2008

Background With the advancement of microsurgical techniques, lamellar keratoplasty （LK） has been more valued and performed to treat corneal blindness. This study aimed to evaluate the indications and changing trends for LK during the past 16 years in Shandong Eye Institute, an eye center in China. Methods A total of 1529 eyes, predominantly from male （70.7%） patients undergoing LK between January 1993 and December 2008, were enrolled in this study. Data were collected by reviewing patient medical records for demographic characteristics, clinical diagnosis, laboratory findings and risk factors. Surgical times, initial diagnoses and causes of regrafting were recorded. All LKs were sequentially divided into period 1 （from 1993 to 2000） and period 2 （from 2001 to 2008）. Results Rural-dwelling patients in this study numbered 1089 （71.2%）; in all cases of infectious keratitis, rural patients accounted for 90.5%. The leading indications for LK were infectious keratitis （31.0%）, corneal trauma （21.1%）, keratoconus （18.7%）, corneal dystrophy and degeneration （7.3%）, regrafting （7.1%）, immunologic disorders （6.7%）, congenital abnormalities and corneal tumor （4.1%） and corneal scarring （3.1%）. The most common subcategory of infectious keratitis was fungal keratitis （67.5%）. Fusarium solani was the most morbigenous fungi. Among the patients, 73.1% of thermal burns were caused by hot molten metal, and 47.8% of alkali burns by lime. Dermoid was the most common indication for congenital abnormalities. The two main initial diagnoses from 109 regrafting cases were corneal trauma （45.9%） and Mooren＇s ulcer （27.5%）. The most common cause for regrafting was immune rejection （35.8%）. Infectious keratitis was the most common indication for LK from 16.0% in period 1 to 41.1% in period 2, followed by keratoconus （16.8%） and corneal trauma （14.5%）. Conclusions During the past 16 years, there have been major changes in the constituent ratios of leading indications for LK in Shangdong. Infectious keratitis has become the most common indication for LK. Fungal keratitis was the most common subcategory of infectious keratitis.