角膜胶原交联术治疗圆锥角膜的疗效和安全性研究

目的：研究角膜胶原交联术治疗圆锥角膜的疗效和安全性。

方法：对2015-04/2018-08在泰国朱拉隆功国王纪念医院行角膜胶原交联术的圆锥角膜患者病历进行回顾性分析。评估术前和术后1a的视力、屈光度、角膜地形图、高阶像差(HOA)、地形图参数和角膜密度。根据患者年龄是否小于24和30岁、基线角膜最大曲率(Kmax)是否小于55 D、基线最佳矫正视力(BCVA)是否小于0.3 LogMAR分组评估年龄、基线Kmax和BCVA对手术疗效的影响。分析术前Kmax、Kmean、平均等效球镜度数(MRSE)、视力、角膜最薄点厚度值、Kmax的变化以及相关参数的变化与角膜密度测量值变化之间的关系。P<0.05具有统计学意义。

结果：共155例患者185眼纳入研究,其中119例男性,36例女性。根据Amsler-Krumeich进行分类,1期和2期占优势(分别为37.84%和35.14%)。术后1a,平均裸眼视力(UCVA)提高0.1 LogMAR(P<0.05)。与基线BCVA较好组(术前BCVA<0.3 LogMAR)相比,基线BCVA较差组(术前BCVA≥0.3 LogMAR)术后BCVA改善大于0.2 LogMAR的眼数较多(78.26% vs 21.74%,P<0.05)。平均Kmax比基线下降2.36 D(P<0.05)。术前Kmax≥55 D的患眼术后Kmax下降超过2.0 D的眼数占比73%。距角膜顶点6 mm处角膜HOA下降0.40(P<0.05)。术后1mo～1a,0～6 mm区角膜密度测量值持续增加。术后1a,角膜密度的增加与最薄点厚度的减少呈线性相关。表面变异指数、高度非对称性指数、圆锥角膜指数、高度轴偏心指数在术后1a时下降(P<0.05)。术后1a,手术成功率为90.24%。术后1wk、1、3、6mo、1a角膜混浊发生率分别为11.35%、30.27%、15.67%、10.27%、2.16%。无角膜水肿发生,但有1例无菌性角膜炎患者。

结论：角膜胶原交联术可有效治疗圆锥角膜,使角膜变平、重塑,提高视力、HOA和角膜形态指数,晚期圆锥角膜Kmax也明显降低。     

Stromal Keratitis with Endophthalmitis Caused by Vittaforma Corneae in an Immunocompetent Patient: A Case Report

Purpose: To describe a case of microsporidial stromal keratitis with endophthalmitis in an immunocompetent patient.Methods: Case reportResults: A 58-year-old HIV-negative man presented with stromal keratitis in his right eye. The patient demonstrated subsequent vitritis, multifocal retinitis and arteritis, and macular edema with recurrent vitreous hemorrhage after therapeutic keratoplasty. Numerous microsporidial spores were detected in corneal tissues by modified trichrome stain. Both corneal tissues and vitreous sample of the affected eye showed positive results by polymerase chain reaction targeting the microsporidial small subunit rRNA gene whose sequences belonged to Vittaforma corneae. Post-keratoplasty and vitrectomy, his best-corrected visual acuity was hand motion due to pale optic disc.Conclusion: Endophthalmitis can be a consequence of microsporidial stromal keratitis in an immunocompetent host. Early recognition and prompt treatment should be considered in patients diagnosed with microsporidial keratitis presenting with mild vitritis, retinitis, and recurrent vitreous hemorrhage.     

Efficacy of azithromycin 1.5% eyedrops vs oral doxycycline in meibomian gland dysfunction: a randomized trial

Graefe's Archive for Clinical and Experimental Ophthalmology - To determine the efficacy of azithromycin 1.5% eyedrops compared with oral doxycycline in patients with moderate to severe...