糖尿病和非糖尿病真菌性角膜炎穿透角膜移植术治疗临床效果的对照研究

背景 真菌性角膜炎是中国主要的致盲眼病之一,糖尿病是真菌性角膜炎的易感人群.穿透角膜移植术是高危真菌性角膜炎患者的主要治疗方法,但目前缺乏糖尿病真菌性角膜炎穿透角膜移植术后的临床疗效评价. 目的 比较糖尿病和非糖尿病真菌性角膜炎患眼行穿透角膜移植术治疗后的临床效果,探讨糖尿病对临床效果的影响.方法 回顾性分析2000年1月至2014年6月在青岛大学医学院附属医院眼科拟行角膜移植术的92例糖尿病真菌性角膜炎患者及106例非糖尿病真菌性角膜炎患者,并比较术后最佳矫正视力(BCVA)、植片排斥反应、真菌复发、并发性白内障及继发性青光眼的发生情况.结果 2个组患者的角膜均为中度和重度感染,其不同感染程度的眼数分布差异无统计学意义(X2 =0.166,P=0.684).2个组间曲霉菌属感染的眼数分布差异无统计学意义(x2=0.340,P=0.854);镰刀菌属感染和念珠菌属感染眼数分布的差异均有统计学意义(X2=2.068,P=0.010;x2=3.874,P=0.049).术后1周～2年,2个组患者术后BCVA均高于术前.糖尿病真菌性角膜炎组患者术后各时间点BCVA＞0.3者均低于相应的非糖尿病真菌性角膜炎组,差异均有统计学意义(均P＜0.05).糖尿病与非糖尿病真菌性角膜炎患者术后排斥反应的发生率分别为42.39％和28.30％,差异有统计学意义(x2=4.306,P=0.038);真菌复发的发生率分别为17.39％和9.43％,差异有统计学意义(x2=3.941,P=0.047);并发性白内障的发生率分别为9.78％和2.83％,差异有统计学意义(x2=4.182,P=0.041);继发性青光眼的发生率分别为5.43％和7.54％,差异无统计学意义(X2=0.358,P=0.055).糖尿病真菌性角膜炎患者不同血糖水平组间术后排斥反应、真菌复发率和术后并发症发生率的比较,差异均无统计学意义(均P＞0.05).结论 与非糖尿病患者相比,糖尿病真菌性角膜炎患者行穿透角膜移植术后视力恢复较慢,移植排斥反应、真菌复发、并发性白内障发生率较高.糖尿病是穿透角膜移植术后发生并发症的危险因素.

A comparative study on clinical outcomes of penetrating keratoplasty for diabetes versus non-diabetes fungal keratitis patients

Background Fungal keratitis is one of the main leading cause of blindness in China,the incidence of which is increasing year by year,while fungal keratitis with diabetes mellitus (DM) also has an increasing trend.Penetrating keratoplasty (PKP) is an effective treatnent for fungal keratitis with high risks,but the study on clinical effect of diabetes mellitus on PKP is still relatively scarce.Objective The clinical data of 92 cases of fungal keratitis with DM and 106 cases of fungal keratitis without systemic disease who underwent PKP were retrospectively reviewed,and the postoperative best corrected visual acuity (BCVA),implant rejection,fungus recurrence,complicated cataract and secondary glaucoma were analyzed and compared.Results Moderate and severe infection were obtained in corneas of the two groups,the eye number distributions of different infection degree and Eurotium infection were not significantly different between the two groups (x2=0.166,P =0.684).The eye number distributions of Eurotium infection had no statistical significance between the two groups (x2 =0.340,P =0.854).The eye number distributions of Fusarium and Candida infection were significantly different between the two groups (x2=2.068,P =0.010;x2 =3.874,P =0.049) The BCVA of the 2 groups from 1 week to 2 years postoperative were all higher than preoperative.The numbers of patients whose BCVA＞0.3 in fungal keratitis with DM group were significantly lower than those in the fungal keratitis without DM group in different time intervals after surgery (all at P＜0.05).The implant rejection rate was 42.39％ in the fungal keratitis with DM group,which was significantly higher than 28.30％ in the fungal keratitis without DM group (x2 =4.306,P =0.038).The fungus recurrence rate was 17.39％ in the fungal keratitis with DM group,which was significantly higher than 9.43％ in the fungal keratitis without DM group (x2 =3.941,P =0.047).In addition,the proportion of complicated cataract patients in fungal keratitis with DM group was 9.78％,which was also higher than 2.83 ％ in fungal keratitis without DM group (x2 =4.182,P =0.041).The incidences of secondary glaucoma were 5.43％ and 7.54％ for fungal keratitis with and without DM,respectively,no significant difference was obtained between the two groups (x2 =0.358,P =0.055).The reject reaction,fungus recurrence rates and incidences of complication were not significantly changed among different blood sugar level groups(all at P＞0.05).Conclusions Compared with fungal keratitis patients without DM,fungal keratitis patients with DM have lower visual improvement,higher rate of implant rejection,fungus recurrence and complicated cataract after PKP.DM is a risk factor of complications after PKP.