中西医结合治疗对单纯疱疹病毒性角膜炎患者视力恢复及血清微量元素的影响

目的:探讨中西医结合治疗对单纯疱疹病毒性角膜炎(HSK)患者视力恢复及血清微量元素的影响。方法:选取2015年1月至2016年10月内蒙古包钢医院收治的HSK患者86例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组43例。对照组采用更昔洛韦滴眼液及硫酸软骨素滴眼液治疗,观察组在对照组基础上结合清肝明目汤进行治疗,2组均连续治疗4周。比较2组患者临床疗效;比较治疗前后2组患者视力恢复状况、血清微量元素及泪液免疫因子水平。结果:治疗后,观察组治疗有效率显著高于对照组,差异有统计学意义(P0.05);治疗后观察组患者视觉模拟评分及视力均显著高于治疗前与对照组,差异有统计学意义(P0.05);治疗后观察组铁离子、钙离子及铜离子水平低于治疗前与对照组,差异有统计学意义(P0.05);血清锌离子水平明显高于治疗前与对照组(P0.05),差异有统计学意义(P0.05);治疗后观察组患者泪液IgA、IgG及C3水平明显高于治疗前与对照组,差异有统计学意义(P0.05)。结论:中西医结合治疗HSK有效促进患者视力的恢复,调节血清微量元素的同时增强患者泪液免疫因子水平,疗效显著优于单用西药治疗。     

高糖饮食对小鼠真菌性角膜炎的影响

目的　探究高糖饮食对小鼠真菌性角膜炎的影响。方法　选取健康无眼疾的雄性C57BL/6J小鼠78只，随机分为高糖饮食组和模型对照组，每组36只，模型对照组给予正常饮用水，高糖饮食组给予含体积分数10%果糖溶液，每2 d测量两组小鼠体质量及血糖，10 d后建立真菌性角膜炎模型。造模后24 h、36 h、48 h、72 h、96 h、120 h、168 h裂隙灯显微镜下对角膜进行临床评分并拍照。处死小鼠后，取角膜组织进行HE染色和PAS染色；测定角膜内中性粒细胞和巨噬细胞浸润体积。利用酶联免疫吸附实验对小鼠角膜内的白细胞介素-1β含量进行测定。结果　造模后 0~14 d，两组小鼠体质量与血糖差异均无统计学意义（均为P>0.05）。造模后24 h、36 h、48 h、120 h、168 h，高糖饮食组小鼠角膜临床评分均明显高于模型对照组，差异均有统计学意义（均为P<0.05）。高糖饮食组小鼠角膜穿孔率79.5%，高于模型对照组的40.9%，差异有统计学意义（P=0.000）。造模后各时间点，高糖饮食组中性粒细胞浸润体积均高于模型对照组，差异均有统计学意义（均为P=0.000）。造模后72 h、96 h、120 h、168 h，高糖饮食组巨噬细胞浸润体积均高于模型对照组（均为P=0.000）。角膜组织病理学检查结果示，高糖饮食组炎症反应更重，角膜组织破坏更早且更为严重。造模后24 h、48 h高糖饮食组白细胞介素-1β含量均明显高于模型对照组（均为P<0.05）。结论　高糖饮食加重了真菌性角膜炎感染的严重程度，增强了中性粒细胞、巨噬细胞的趋化，促进了IL-1β的分泌。     

Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis

Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the “anti-biotic era”. Although, we have expeditiously developed our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts required for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins.In this review article, we provide an overview of the established diagnostic techniques and therapeutics for keratitis caused by various bacteria. We extensively report the recent in-roads through novel tools for accurately diagnosing mono- and poly-bacterial corneal infections. Furthermore, we outline the recent progress by our groups and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discuss in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.     

Suppurative corneal ulceration in Bangladesh

Suppurative keratitis is an important preventable cause of blindness, particularly in the developing world. This study analyses 142 cases of suppurative keratitis referred to Chittagong Eye Infirmary, Bangladesh. Some 53.5% of cases were bacterial and 35.9% were fungal. The five most common pathogens were: Pseudomonas sp. 24%, Streptococcus pneumoniae 17%, Aspergillus sp. 13%, Fusarium sp. 7% and Curvularia sp. 6%. Gram stain and culture results were consistent in 62.6% of cases. Previous antibiotic treatment was a significant factor for failure of culture isolation and less so for Gram stain failure. On Gram stain, 55.9% of pseudomonal cases were missed, but only 2% of fungal cases were missed. Over all, Gram stain had a sensitivity of 62% and positive predictive value of 84% for bacterial cases, and 98% and 94% for fungal cases, respectively. Fungal ulcers were typically filamentous, but an antecedent history of trauma was not common. The most frequent injury was due to rice grains, but the inoculum appeared to be introduced during eye washing with contaminated water. Pseudomonal ulcers occurred most frequently in the monsoon season, and Fusarium cases were seen only in the hot, dry season.     

微量地塞米松与抗病毒药物合用对抗单疱病毒作用的影响

报告在组织培养中地塞米松对单纯疱疹病毒(HSV)的生长繁殖无影响,对无环鸟苷(ACV)和环胞苷(CC)的抗病毒作用亦无干扰。在动物实验中,微量地塞米松[0.001%,常用浓度(0.1%)的百分之一]并不恶化上皮型HSV角膜炎。同时证明有效抗病毒药物的合用,微量地塞米松仍保留有良好的消炎作用,能促进上皮型和实质层型单疱角膜炎的痊愈过程。     

中西医联合治疗单纯疱疹性角膜炎的疗效观察

目的 :探讨单纯疱疹性角膜炎是中西医联合用药的治疗方法。方法 :本组 10 0例 ( 10 6只眼 )单纯疱疹性角膜炎患者应用抗病毒药物联合清热解毒中药的疗效观察。结果 :本组病例治疗后总有效率 82 .0 8%。结论 :中西医联合治疗措施是我们对单纯疱疹性角膜炎治疗的一项新的探讨。     

Non-ulcerative fungal keratitis diagnosed by posterior lamellar biopsy*

We report a case of Fusarium solani keratitis which highlights the difficulties often associated with management of fungal corneal infections. This case demonstrates several unusual and interesting features: the occurrence of deep fungal pathology after superficial injury, the difficulties encountered in attempting to isolate and identify the causative organism, and the protracted course taken by an organism often noted to be rapidly destructive. These features necessitated an individual approach to therapy, employing unconventional medical and surgical techniques to achieve a satisfactory outcome     

口服阿昔洛韦在单疱病毒性角膜炎行角膜移植术后的应用

目的　评价单纯疱疹病毒性角膜炎患者行穿透性角膜移植术后,口服阿昔洛韦预防单纯疱疹病毒性角膜炎复发的疗效。方法　1999年1月至2 0 0 3年12月单纯疱疹病毒性角膜炎5 2例5 2眼行穿透性角膜移植术,术后给予口服阿昔洛韦2 0 0mg 5次/d ,服用2m～3m后减为4 0 0mg 2次/d ,继续服用3m后停止,分析单纯疱疹病毒性角膜炎复发的情况。结果　在口服阿昔洛韦期间,无一例出现单纯疱疹病毒性角膜炎的复发。术后经12m～38m (2 2 .8±9. 6 )的随访,4 9眼植片透明,3眼因排斥反应植片混浊。32眼(6 1 .5 % )最佳矫正视力好于0 . 5 ,4 9眼(94 . 2 % )最佳矫正视力好于0 . 1,3眼(5 . 8% )低于0 . 1。结论　口服阿昔洛韦能有效预防单纯疱疹病毒性角膜炎行穿透性角膜移植术后的复发     

汽车安全气囊所致的眼外伤

目的：报告了因汽车安全气囊造成的眼外伤及化学性烧伤。希望引起眼科同仁的高度重视．方法：４例病人均是进口高档小卧车，在发生碰撞时因汽车安全气囊高速膨胀打开及气囊破裂所致的眼损伤及化学烧伤．分析了汽车型号及种类，事故发生时的速度，眼损伤的类型和视力情况．结果：第一例病人为碱性化学性角膜炎伴虹膜根部离断及瞳孔括约肌破裂而造成瞳孔扩大；第二例病人为近视镜片致角巩膜板层撕裂伤；第三例病人为广泛角膜擦伤伴前房出血；第四例病人为视网膜水肿出血伴后极部脉络膜裂伤．结论：安全气囊能保护生命降低致伤率，但因气囊的冲击力量引起的机械损伤和气囊中强碱性气体导致的化学烧伤更要引起国内眼科医生的注意．     

准分子激光原位角膜磨镶术后界面性角膜炎的临床观察

目的 :动态观察准分子激光原位角膜磨镶术 (LASIK)后界面性角膜炎 (DLK)的临床变化 ,同时对其角膜瓣下临床特点及处理方法进行分析。　方法 :对 35 0 0例行LASIK后 1 0例 (1 8只眼 )发生DLK患者进行观察。按3、7、1 4天和 1、2、6个月不同时间进行视力、裂隙灯显微镜检查。　结果 :局部用激素、抗生素治疗 1周 ,症状控制 ,1～ 2个月全部吸收。视力恢复至 1 .0～ 1 .5 (1 6只眼 ) ,0 .8～ 1 .0 (2只眼 )。　结论 :LASIK后DLK常发生在术后 1～ 7天内 ,迟发者偶见 ,男性多于女性 ,以局部激素治疗为主 ,严重患者需全身激素加抗生素治疗。DLK早期须与角膜上皮植入、层间感染鉴别