角膜板栗刺异物伤15例的临床观察

目的：探讨目前角膜板栗刺异物伤有效治疗方法及影响病情进展的因素。方法：回顾性分析2014－07／2015－10武汉市同济医院眼科病房收治的角膜板栗刺异物伤患者15例15眼的临床资料，入院时未并发真菌性角膜炎的患者在剔除角膜板栗刺异物的同时均积极给予以那他霉素为主的抗真菌治疗，而对入院时已并发真菌性角膜炎的患者予以氟康唑溶液前房冲洗和角膜基质层注药，必要时予以羊膜移植术或角膜移植术，总结上述治疗方法的有效性及影响病情进展的因素。结果：入院时未并发角膜溃疡病例11例，入院时平均病程为1～7（2．42±2．15）d，入院时已并发真菌性角膜溃疡病例4例，入院时病程为3～30（18．25±4．35）d。其中并发角膜溃疡病例板栗刺数量平均为4．5根，并均有板栗刺穿透角膜进入前房；未发生角膜溃疡病例板栗刺数量平均为3．5根，而只有28．5％病例有板栗刺穿透角膜进入前房。经抗真菌治疗和相应手术治疗后，所有病例均被判定为治疗有效。结论：影响角膜板栗刺异物伤病情进展的因素可能有板栗刺的数量、板栗刺是否穿透角膜进入前房、就诊时病程的长短、是否积极进行抗真菌治疗等。对已并发真菌性角膜炎的病例积极予以抗真菌药物能有效控制真菌性角膜炎的进展，为进一步行羊膜移植或角膜移植术创造有利条件。

Clinical observation of 15 cases of corneal foreign body injuries caused by chestnut thorns

AIM:To investigate the effective treatment methods of corneal injury caused by chestnut thorns and the factors affecting the disease progression.

METHODS: From Jul. 2014 to Oct. 2015, the clinical data of 15 patients(15 eyes)with corneal injury caused by chestnut thorns in Ophthalmology Inpatient Department of Wuhan Tongji Hospital was retrospective analyzed. The patients without fungal keratitis were treated with the surgery of removing chestnut thorn from cornea and antifungal drugs. For the patients complicated with fungal keratitis, besides surgery of removing chestnut thorn and antifungal drugs, anterior chamber irrigation and corneal stroma injection with fluconazole solution were given to treat the disease. If necessary, amniotic membrane transplantation or keratoplasty was also given to the patients complicated with fungal keratitis. After that, the effectiveness of those methods and the factors affecting progression were analyzed.

RESULTS:For 11 patients without fungal keratitis, the average time between corneal injury and receiving treatment at Tongji Hospital was 1-7(2.42±2.15)d and for 4 patients complicated with fungal keratitis, the average time was 3-30(18.25±4.35)d. Among 15 cases, statistics suggested that the average number of chestnut thorn in patients complicated with fungal keratitis was 4.5, and all the chestnut thorn penetrated the cornea into the anterior chamber. The average number of chestnut thorn in patients without fungal keratitis was 3.5, and the proportion of chestnut thorn penetrated the cornea into the anterior chamber was 28.5%. After treatment, all patients had no new fungal keratitis or other complications. Those results indicated that the different treatments for the patients with or without fungal keratitis were all effective.

CONCLUSION:The factors affecting the progression of cornea foreign body injury caused by chestnut thorn are the number of chestnut thorn, whether chestnut thorn penetrate the cornea into the anterior chamber, time since injury, active anti-fungal therapy. If patients complicated with fungal keratitis could be treated with antifungal agents and anterior chamber irrigation or corneal stroma injection using fluconazole solution without delay, the progress of fungal keratitis could be effectively controlled, and favorable conditions for further therapy such as amniotic membrane transplantation or keratoplasty could be provided.