重症真菌性角膜炎患者的临床特征分析

目的:探讨重症真菌性角膜炎病因、人群特征及临床特点。方法:搜集2008-01/2013-11就诊于我院眼科的233例233眼重症真菌性角膜炎患者的临床资料,回顾性分析其病因、人群特征、临床特点等情况。结果:重症真菌性角膜炎233例患者中,男153例(65.7%),男女比例约为1.9∶1;年龄分布中,中老年龄段人数居多,平均年龄52.7±11.3岁;居住地多为农村(78.1%);并且其职业以农民为主(66.1%),发病患者文化程度普遍较低(59.7%);重症患者中,188例(80.7%)患者具有明确的眼部外伤史,以植物性外伤为主(60.9%)。主要致病菌属为镰刀菌属,为90例(57.3%),其次为曲霉菌属47例(29.9%);治疗中手术率为87.9%。其中多数行穿透性角膜移植术,为83例(52.9%),在镰刀菌及曲霉菌感染的重症角膜炎患者中,行穿透性角膜移植术者比例较高,为58.4%(80/137);行眼内容剜除术或眼球摘除术的重症患者中,68.4%(13/19)的患者为镰刀菌属感染。结论:我院重症真菌性角膜炎患者多为农村居住的中老年男性农民,可能与其经济条件及诊疗意识差有关。其主要致病菌为镰刀菌及曲霉菌属,穿透性角膜移植手术为主要治疗手段,且预后差的重症患者多为镰刀菌感染。

Clinical features of patients with severe fungal keratitis

AIM: To explore the predisposing factors, population characteristics and clinical features of severe fungal keratitis.

METHODS:The data of 233 cases 233 eyes of severe fungal keratitis in my hospital from January, 2008 to November, 2013 was retrospectively reviewed. The predisposing factors, population characteristics and clinical features were analyzed.

RESULTS: In 233 cases of severe fungal keratitis, the number of male patients was 153(65.7%)and the number ratio of male to female was 1.9:1. The average age of them was(52.7±11.3), and most of them were middle-aged and elderly people living in the rural area(78.1%)and were farmers(66.1%)with low literacy(59.7%). In 233 cases, 188 cases(80.7%)possessed a clear history of ocular trauma, mainly caused by plant-based trauma(60.9%). 90 cases(57.3%)were infected with Fusarium, and 47 cases(29.9%)by Aspergillus. The main treatment of severe fungal keratitis was surgery(87.9%). 83 cases(52.9%)were treated with penetrating keratoplasty, and in Fusarium and Aspergillus infected patients with severe fungal keratitis, 58.4%(80/137)were performed with penetrating keratoplasty. In addition, patients treated with eye enucleation or evisceration, 68.4%(13/19)were infected with Fusarium species.

CONCLUSION: Patients with severe fungalkeratitis in our hospital are mainly elderly male farmers living in rural, because of low economic condition and poor diagnosis consciousness. The main pathogens are Fusarium and Aspergillus species, and the major treatment is penetrating keratoplasty. Most of patients with poor clinical outcomes are infected with Fusarium species.