Infectious keratitis after transepithelial photorefractive keratectomy: A case report

Transepithelial photorefractive keratectomy (tPRK) promotes faster re-epithelialization which in turn can reduce the risk of infectious keratitis in the postoperative period. We present a case of a 22-year-old man with infectious keratitis in his left eye 8 days after an uneventful bilateral tPRK. A 2 mm × 5 mm anterior stromal area of corneal infiltration with a same sized overlying epithelial defect was noted at the time of presentation. His uncorrected distance visual acuity was 20/63 in his left eye. Corneal scrapings showed Bordetella bronchiseptica. The infection responded to intensive treatment with topical levofloxacin 0.5% eye drops. The final visual acuity was 20/20 in the left eye.     

环孢素A联合抗真菌药物体外抗茄病镰刀菌效果研究

目的：研究免疫抑制剂环孢素A联合使用抗真菌药物对镰刀菌体外抗真菌药物敏感性的影响。

方法：采用美国临床实验室标准化委员会(CLSI)M27-Ed4及M38-A3方法测定伏立康唑(voriconazole)、那他霉素(NAT)和两性霉素B(Amphotericin B)及氟康唑(FLU)对22株镰刀菌的最低抑菌浓度(MIC),棋盘法测定四种抗真菌药物单独及联合环孢素A使用抗真菌作用。

结果：那他霉素、伏立康唑、两性霉素B和氟康唑对镰刀菌(22株)MIC范围分别是2～8、1～8、1～8和8～512μg/mL。体外联合用药时,环孢素A与氟康唑对64%菌株(14/22)有协同效应,与两性霉素B对41%菌株(9/22)有协同效应,对所有菌株无拮抗效应。联合使用环孢素A后,镰刀菌对两性霉素B药物敏感性由4.5%提升至68.2%(P<0.001)。

结论：镰刀菌在体外对那他霉素敏感,对伏立康唑部分敏感。与环孢素A联合应用时,可与氟康唑及两性霉素B产生协同效应,并显著提高镰刀菌对两性霉素B药物敏感性。     

铜绿假单胞菌性角膜炎发病机制的研究进展

铜绿假单胞菌性角膜炎是临床上常见的角膜炎之一,其起病急、发展迅速,并且治疗棘手。若未及时治疗,极易形成角膜溃疡,严重时可致盲。为增加有效治疗的手段,深入研究其发病机制有重要意义。本文就铜绿假单胞菌的致病性与宿主的免疫反应在铜绿假单胞菌性角膜炎的发病机制中所起的作用进行了概述,以期为其治疗的新思路提供理论依据。     

自身免疫病相关性角膜炎的研究进展

自身免疫病(autoimmune disease,AID)相关性角膜炎是以角膜炎症、角膜新生血管为主要特征,无活动性角膜感染表现。AID相关性角膜炎进展迅速,治疗难度大。其病因复杂多样,常见于类风湿性关节炎、系统性红斑狼疮、肉芽肿合并多发性脉管炎、Cogan综合征、冷卟啉相关周期性综合征、干燥综合征等。AID相关性角膜炎多与遗传因素、某些病毒的感染和自身免疫调节功能异常相关,但其具体发病机制尚不明确。(国际眼科纵览,2020,44:397-401)     

角膜基质内注射不同浓度伏立康唑治疗真菌性角膜炎

目的观察角膜基质内注射不同浓度伏立康唑治疗真菌性角膜炎的临床疗效。方法前瞻性病例对照研究。87例(87眼)真菌性角膜炎患者随机分为三组,均行KOH湿片检查和真菌培养,A组(28眼)给予5 g·L^-1氟康唑和50 g·L^-1那他霉素滴眼液滴眼,B组(30眼)和C组(29眼)在A组治疗的基础上再分别给予0.25 g·L^-1和0.50 g·L^-1的伏立康唑行角膜基质内注射。术后随访4个月,观察三组患者的疗效及并发症情况。结果KOH湿片检查阳性率为86.2%(75/87),真菌培养阳性率为93.1%(81/87);前三位的致病菌依次是镰刀菌40例(46.0%),曲霉菌19例(21.8%),链格孢霉菌13例(15.0%),三组患者致病菌分布差异无统计学意义(χ^2=0.932,P=0.988)。A组的治愈率为42.9%(12/28),明显低于B组的76.7%(23/30)和C组的86.2%(25/29),差异均有统计学意义(P=0.009、0.000);B组和C组治愈率比较差异无统计学意义(P=0.347)。A、B、C三组的治愈时间依次为(31.96±10.20)d、(26.17±7.23)d和(21.50±7.32)d,两两相比差异均有统计学意义(均为P<0.05)。A组治疗前后视力比较差异无统计学意义(P=0.905);B、C两组治疗前后视力比较差异均有统计学意义(P=0.027、0.022)。B、C两组的注射次数分别是(3.93±1.26)次和(3.41±1.12)次,差异无统计学意义(P=0.099)。未愈者A组16眼、B组7眼、C组4眼。结论对轻度、中度真菌性角膜炎患者可选择0.25 g·L^-1伏立康唑角膜基质内注射治疗,对于0.25 g·L^-1伏立康唑角膜基质内注射治疗效果不理想或病情较重者可考虑用0.50 g·L^-1伏立康唑行角膜基质内注射治疗。     

The expression of lacrimal androgen-binding proteins in mice Pseudomonas aeruginosa keratitis

AIM: To investigate the expression of lacrimal androgenbinding proteins(ABPs) in mice Pseudomonas aeruginosa(P. aeruginosa) keratitis.METHODS: P. aeruginosa mice model from different gender was developed by intra-stromal injection. The expression of lacrimal ABPs in lacrimal gland specimens from P. aeruginosa keratitis mice was detected by the quantitative polymerase chain reaction(q RT-PCR). Corneal virulence was evaluated based on clinical scores. To study the mechanism of lacrimal ABPs' expression, experimental subjects were pre-treated with 4 E-BP1 inhibitor, and were used to evaluate the expression levels by q RT-PCR.RESULTS: Compared with control groups, the expression of ABPα, ABPη and ABPζ in lacrimal gland from P. aeruginosa keratitis mice had no meaningful changes, while ABPε and ABPδ were significantly higher at 1 d after infection. The expression of ABPδ in lacrimal gland of male mice was higher than female mice, regardless of whether or not P. aeruginosa keratitis occurred. After 4 E-BP1 inhibitor subconjunctival injection or lacrimal injection, the expression of ABPδ and ABPε has no significant change compared with the control group.CONCLUSION: ABPδ and ABPε secreted by mice lacrimal gland may involve in the progress of alleviating the severity of corneal damage in P. aeruginosa keratitis. The expression of ABPδ and ABPε upon P. aeruginosa infection is independent of cap-dependent m RNA translation activated by 4 E-BP1.     

Changes in corneal innervation and pain responses in fungal keratitis

AIM: To characterize changes in the cornea nerve and pain responses in fungal keratitis (FK). METHODS: A retrospective analysis of in vivo confocal microscopy images of 11 FK corneas was performed, and the results were compared with those for 11 normal corneas. Subbasal corneal nerves were analyzed for total nerve number, main nerve trunk number, branching patterns and tortuosity. C57BL/6 mice were infected with Aspergillus fumigatus. Disease severity was determined through clinical scoring and slit lamp photography. Corneas were harvested at 1, 3, 5, and 7d post infection (p.i.) and assessed for β III tubulin. Corneal mechanical sensitivity thresholds were detected by von Frey test. β-endorphin (β-EP) and μ receptor protein expression was detected through Western blotting. RESULTS: Total nerve number, main nerve trunk number, and nerve branching were significantly lower in FK patients than in controls, but tortuosity was not significantly different. In infected mice, subbasal nerve density decreased from 1d p.i., reaching a minimum at 5d p.i. Clinical scores rose at 1d p.i., peaked at 3d p.i., and decreased at 5d p.i. Mechanical sensitivity thresholds showed the same trends. β-EP and μ receptor protein expression increased after infection. CONCLUSION: Corneal nerve density is lower in FK patients and Aspergillus fumigatus-infected mice than in controls. Pain sensitivity decreases with postinfection corneal ulcer aggravation. β-EP and μ receptor proteins are both upregulated in infected mouse corneas.     

自体血清治疗单纯疱疹病毒性角膜炎的疗效观察

目的 观察自体血清滴眼治疗单纯疱疹病毒性角膜炎（herpes simplex keratitis,HSK）的临床效果.方法 把68例76眼随机分成两组,对照组按照常规HSK给予抗病毒类药物治疗,治疗组在对照组基础上加用自体血清滴眼治疗.结果 所有的HSK患者中,治疗组治愈率80.0％,有效率为100.0％;对照组治愈率50.0％,有效率为97.2％,两组比较治疗组治愈率高于对照组（x^2 =8.462,P =0.015）.治疗前后比较显示,治疗组经治疗后疗效变化有统计学差异（P＜0.01）,对照组变化无统计学差异（P＞0.05）;经治疗,治疗组和对照组视力分布有统计学差异（x^2 =6.043,P =0.049）.结论 自体血清滴眼治疗HSK是明显有效的.     

更昔洛韦眼用凝胶治疗单纯疱疹病毒性角膜炎的疗效观察

目的：探讨更昔洛韦眼用凝胶治疗单纯疱疹病毒性角膜炎（HSK）的疗效及预防复发的作用。方法：HSK患者64例随机分为更昔洛韦组与对照组各32例。更昔洛韦组予0．15％更昔洛韦眼用凝胶和0．3％氧氟沙星眼液交替滴眼,qid。对照组予0．1％阿昔洛韦滴眼液和0．3％氧氟沙星眼液交替滴眼,qid。两组疗程均为3周。观察两组患者治疗后临床疗效和不良反应,并随访观察治疗后2年内的复发率。结果：治疗3周后,更昔洛韦组临床总有效率明显高于对照组（P〈0．05）。两组分别出现不良反应3例和5例,不良反应发生率比较,差异无统计学意义（P〉0．05）。治疗后随访2年,观察组患者复发率明显低于对照组（P〈0．05）。结论：更昔洛韦眼用凝胶治疗HSK疗效确切,安全性较好,能减少其复发率,具有治疗和预防HSK复发的作用。