加速型角膜胶原交联术治疗真菌性角膜炎的临床研究

目的 评价角膜胶原交联术(CXL)治疗真菌性角膜炎的安全性和临床效果。 方法 对2017年1月-2019年12月期间济南市第二人民医院眼表疾病科确诊为“真菌性角膜炎”的患者92例(92眼),进行CXL治疗(观察组);同时回顾性分析2016年1月~2017年2月本院真菌性角膜炎单纯应用药物治疗的患者47例(47眼)的临床资料(对照组)。入组标准:病变深度<角膜厚度2/3;浅层的角膜溃疡,病变未累及的正常角膜厚度>400 μm;病变直径在3~6 mm范围、病变位置均偏离或少量影响瞳孔区;共聚焦显微镜可见真菌菌丝,真菌培养结果为镰刀菌。对两组治疗效果进行对比分析。 结果 观察组在术后2周开始,最佳矫正视力有显著改善,治疗效果优于对照组,差异有统计学意义(P<0.001);术后3个月最佳矫正视力较术前有显著提高,效果优于对照组,差异有统计学意义(P<0.001);观察组治疗2周后所有患眼的病变范围均保持稳定或缩小,术后3个月时,全部患眼病变区域均形成云翳,检查上皮愈合良好;观察组术后2周和术后1个月的真菌检出阳性率明显低于对照组,两组差异有统计学意义(P<0.001);随访期间,观察组所有患者均无真菌性疾病复发,且无并发症出现。 结论 针对范围较小、偏中心的真菌性角膜炎,CXL可以显著缩短病程,提高视力,是一种安全有效的治疗方法。

Clinical study of accelerated corneal collagen crosslinking in the treatment of fungal keratitis

Objective To evaluate the safety and effectivity of corneal collagen cross-linking(CXL)in the treatment of fungal keratitis. Methods In the experimental group, 92 patients(92 eyes)with “fungal keratitis” were treated with CXL from January 2017 to December 2019, whereas in the control group, clinical data of 47 patients(47 eyes)(control group)with fungal keratitis whoreceiveddrug treatment alone in our hospital from January 2016 to February 2017 were retrospectively analyzed. The inclusion criteria were as follows: lesion depth <2/3 of the corneal thickness,superficial corneal ulcer with a normal corneal thickness >400 μm, lesiondiameter between 3-6 mm, deviation or slight affectation of the pupil area due to the location of the lesion,fungi hyphae on confocal microscopy,and positive Fusarium resultson fungal culture. Therapeutic effects were compared and analyzed between the two groups. Results At 2 weeks postoperatively, the best corrected visual acuity significantly improved in the experimental group, showing a better treatment effect than that in the control group(P<0.001). At 3 months postoperatively, the best corrected visual acuity significantly improved as compared to preoperative findings, with a better treatment effect in the experimental group than that in the control group(P<0.001). In the experimental group, the lesion scope of all eyes remained stable orreduced after 2 weeks of treatment. At 3 months postoperatively, clouds were observed in the lesion area of all eyes with good epithelial healing. The positive rate of fungi was significantly lower in the experimental group than in the control group(P<0.001)at 2 weeks and 1 month postoperatively. During follow-up, all patients in the test group had no fungal recurrences and complications. Conclusion CXL is a safe and effective treatment for fungal keratitis cases with a small range and partial center, as it can significantly shorten the disease course and improve vision.