接触镜相关的感染性角膜炎防治研究进展

近年来,接触镜相关的感染性角膜炎发生率明显下降,然而,随着配戴者的迅速增多以及棘阿米巴原虫感染的出现,其防治工作将日益眼巨。对于包括抛弃型镜片与高透氧镜片的各种接触镜,过夜配戴,对医嘱依从性差仍是其主要危险因素。本文根据近年有关文献,就其流行病学与危险因素、发生机制、临床特点、实验诊断、治疗与预防进行了简要综述。     

抛弃型角膜接触镜研究进展

角膜接触镜 (contact lens,CL )材料科学与生产工艺特别是全自动铸模工艺的发展使抛弃型 CL (disposable CL ,DCL)得到迅速发 [1～ 3] 。目前的 DCL 均属于以聚甲基丙烯酸羟乙酯 (polyhydroxyethyl m ethacrylate,H EMA)等亲水性材料为主要原料生产的软性 CL(SCL) ,因此亦称抛弃型 SCL(disposable SCL ,DSCL )。近年的临床实践表明 ,DCL虽然方便了护理 ,使一些并发症的发生率显著降低 [4～ 1 3] ,然而 ,包括日抛镜片 (Daily DCL,DDCL)在内均未能完全杜绝 CL 并发症的发生 ,一些并发症的发生率甚至有所增加 [1 4～ 2 0 ]。…     

角膜接触镜相关的微生物学研究进展

微生物感染性角膜炎是配戴角膜接触镜最为严重的并发症。本文根据近年有关文献 ,就角膜接触镜相关的眼部感染的微生物学以及如何通过研发高性能的角膜接触镜与护理液 ,合理配适 ,科学护理来预防感染性眼病的发生进行了综述。     

角膜接触镜护理研究进展

角膜接触镜作为一种医疗用品,可以取代眼镜,用于矫正屈光不正。护理与保养是接触镜实现其光学矫正功能,以及其舒适、安全与成功佩戴的必要条件。接触镜护理产品研究的主要目标是高效、安全、方便。上前常用的接触镜护理方法有热消毒、化学消毒与Ｈ２Ｏ２消毒,但尚没有一种理想者。为保障佩戴安全,需要医生经予每个患者做详细的佩戴指导,患者应严格执行医嘱。接触镜护理不当可引起危及视力的感染性角膜炎。应让患者了解佩戴接触     

接触镜性角膜炎及其实验研究

接触镜性角膜炎及其实验研究潍坊医学院附属医院眼科李贵仁，王杰，张少斌，马宁潍坊医学院附属医院检验科成可经角膜接触镜临床应用以来，在矫正屈光不正和治疗某些眼病方面有很多优点，但其所致角膜炎的报告亦日渐增加［１］，１９８５年７月－１９９３年７月笔者共收治...     

与接触镜相关的角膜疾病及其防治

角膜接触镜的增视，美容和方便的特点使其在世界各地被广泛使用。但在其配戴过程中，可引起一系列的眼部生理变化，如：角膜厚度增加，角膜电位改变，葡萄糖代谢改变，角膜缺氧，二氧化碳分压增加，ＰＨ值下降，角膜表面温度下降等，对某些长期配戴，还可能发生各种较严重的并发症，如：微生物性角膜炎，代谢性，毒性和变应性角膜病变。本就此及其防治作简要综述。     

角膜接触镜相关感染性角膜炎20例临床特征

目的：观察角膜接触镜相关感染性角膜炎的临床特征及治疗转归,以期对临床诊疗提供参考。方法：回顾性观察2009年7月到2019年6月因配戴角膜接触镜发生感染性角膜炎而住院的患者,收集并分析患者的高危护理行为、症状体征、角膜感染灶的特点、病原学检查结果、治疗经过以及病情转归。结果：共20例患者（23眼）纳入本研究,女12例,男8例,平均年龄21.4岁。连续数日配戴及自来水清洗镜片占高危护理行为的72%（8/11）。最常见的临床症状是眼异物感、疼痛、眼红及视力下降。溃疡位于视轴区及视轴旁区15眼（65%）,位于周边区8眼（35%）。病原学检查阳性率为35%（8/23）,4眼为棘阿米巴感染,其中2眼合并表皮葡萄球菌感染;3眼为铜绿假单胞杆菌感染;1眼为表皮葡萄球菌感染。16眼（70%）药物治愈,7眼（30%）手术联合药物治愈。治疗效果佳为8眼（35%）,效果良好为9眼（39%）,效果差为6眼（26%）。结论：连续数日配戴及自来水清洗镜片是引发接触镜感染的重要危险因素;溃疡好发于视轴及视轴旁区;棘阿米巴原虫及铜绿假单胞杆菌是感染最常见的病原体。经过及时合理的药物及手术治疗,多数可获得满意疗效。     

软性角膜接触镜与角膜新生血管

复查长戴型软接触镜配戴者203人（406）眼。对其因戴镜所致的角膜新生血管的发生与配戴者的性别、职业、屈光度、戴镜方式、镜片使用时间及服部炎症等因素之间的关系进行分析。     

接触镜相关性棘阿米巴性角膜炎防治研究进展

棘阿米巴 (acantham oeba)是一种在自然界中广泛分布的自由生活原虫。棘阿米巴性角膜炎 (acanthamoeba kerati-tis,AK)最早于 1973年报道。1985年 ,证实 AK与配戴角膜接触镜 (contact lens,CL) ,特别是软性 CL(soft CL,SCL)密切相关 ,AK成为对 CL配戴安全的严重威胁。然而 ,CL相关性 AK(CL associated AK,CL AAK)是可以预防的。本文就近年来有关 CL AAK防治的国内外研究进展进行了简要综述。1　 CL AAK流行病学CL AAK最早报道见于 1984年。1989年 ,美国疾病控制中心 (CDC)的 Stehr- Green等对 2 0 8例 AK患者所做的流…     

Rethinking contact lens associated keratitis

This review presents a critical analysis of the literature relating to the use of binomial and polynomial classification schemes for categorising corneal infiltrative events (CIEs) associated with contact lens wear and the epidemiology of such events. The results of the Manchester Keratitis Study—a 12‐month, prospective, hospital‐based epidemiological study of contact lens wearers suffering from CIEs—are used as a tool to challenge and test traditional thinking in relation to contact lens associated keratitis. An innovative aspect of this study is the use of a novel clinical severity matrix to systematically score the severity of CIEs based on 10 key signs and symptoms. The ambiguities inherent in using binomial classification schemes (such as, microbial versus sterile, ulcerative versus non‐ulcerative et cetera) are highlighted. The failure of a polynomial scheme—due to extensive classification overlap between proposed sub‐types of CIEs—is demonstrated using a Venn diagram. A cartographic analysis reveals that infiltrates tend to occur in the superior cornea of patients wearing extended wear silicone hydrogel lenses, in the central cornea of patients wearing daily wear hydrogel daily disposable lenses and in the peripheral cornea of patients wearing daily wear hydrogel (excluding daily disposable) lenses. Infiltrates that occur more towards the limbus are less severe. The incidence of CIEs is higher when contact lenses are worn overnight. Logistic analysis reveals that the risk of developing a severe CIE is five times greater with conventional hydrogel extended wear versus silicone hydrogel extended wear. The male gender, smoking, a healthy eye and body, and the late Winter months are associated with an increased risk of developing CIEs. The rate of significant visual loss as a result of developing a CIE is low. Two key conclusions are drawn from this work, which represent a radical rethinking of this potentially sight‐threatening condition.

• 1 CIEs should be considered as a continuous spectrum of ocular disease.
• 2 If a contact lens wearer presents with a sore eye that is becoming progressively worse and a CIE is observed in that eye, lens wear should be suspended and anti‐microbial therapy initiated immediately.

     

Curative effect assessment of bandage contact lens in neurogenic keratitis

AIM:To observe the curative effect of bandage contact lens in neurogenic keratitis.METHODS:Twenty cases of neurogenic keratitis were studied attheDepartment of Ophthalmology, the first Affiliated Hospital of China Medical University, between October 2012 and June 2013. These included 13 males and 7 females, aged from 35 to 88y. Patients were voluntarily divided into an experimental group (lens wearing group, n=10) and control group (drug therapy, n=10). In experimental group patients wore silicone hydrogel bandage soft contact lens. Both groups used the following eyedrops:0.5% levofloxacin TID; 0.5% Sodium carboxymethyl cellulose QID; fibroblast growth factor BID; ganciclovir BID [cases complicated with herpes simplex virus (HSV)]; compound tropicamide BID (cases concurrent hypopyon). The healing time of corneal ulcer and complication rates were observed in the two groups.RESULTS: The healing time of corneal ulcer in the experimental group was 10.80±4.44d versus 46.70±13.88d in the control group (P＜0.05). No complications occurred in the experimental group, except for the lens falling off twice in one case, the patient recovered eight days after rewearing the lens. While in the control group, all cases vascularized, 2 cases were complicated with descemetocele that recovered with amniotic membrane transplantation and 1 case was complicated with corneal perforation that recovered by autologous conjunctival flap covering.CONCLUSION: Bandage contact lens is a safe and effective method of treating neurogenic keratitis and significantly shortened the healing time of corneal ulcer.     

镰孢菌属镰刀菌致与接触镜有关的真菌性角膜炎1例(英文)

目的:报道1例罕见的被确诊为由镰孢菌属镰刀菌引起的与接触镜有关的严重的真菌性角膜炎,该病例最后通过治疗性穿透性角膜移植术成功治疗。方法:病例报告。结果:一位39岁的马来西亚女士,私企职员,配戴长戴性软性接触镜18a。感右眼剧痛、眼红10d。眼部检查见多个长有伪足的圆形旁中心角膜溃疡,前房少许积脓,临床诊断为真菌性角膜炎。经重复角膜刮片检查真菌和细菌结果均阴性后给予局部广谱抗生素和抗真菌治疗,但患者右眼角膜炎病情进一步加重,又给予其他的局部和全身抗真菌药物治疗,患者右眼角膜溃疡进一步加深。最后,为保留眼球,限制感染,在发病1.5mo后,给予患者治疗性的穿透性角膜移植术。术后,角膜组织病理学检查和PCR检查证实为镰孢菌属镰刀菌感染所致。结论:这是1例罕见的由镰孢菌属镰刀菌感染引起的严重的与接触镜有关的真菌性角膜炎。这也说明了在真菌性角膜炎的治疗上存在挑战性。为控制真菌性角膜炎进一步发展,并保护眼球,治疗性的穿透性角膜移植术应该是最后的选择。     

Peripheral ulcerative keratitis due to a 'long lost' hard contact lens

Peripheral ulcerative keratitis (PUK) is a disorder consisting of a crescent-shaped destructive inflammation of the perilimbal corneal stroma. PUK can occur in a variety of ocular and systemic conditions including infections, lid abnormalities, dermatological disorders and connective tissue disorders. We present a case of PUK associated with a hard contact lens (CL) retained in the superior fornix for over 16 years. After removal of the embedded CL, a superior forniceal conjunctival pedicle graft was performed to prevent corneal perforation. The patient was managed postoperatively with a combination of topical steroids and antibiotics. The use of systemic immunosuppressive therapy was not necessary. Micro-trauma and micro-keratitis may have occurred as a result of the mechanical effect of the CL but if this was the sole mechanism, one would expect presentation at a much earlier date. We discuss the pathogenetic mechanisms which may have contributed to the development of this ulceration. This report highlights the importance of lid eversion when examining patients with anterior segment pathology.     

Acanthamoeba keratitis and contact lens wear

Acanthamoeba keratitis is a rare but serious complication of contact lens wear that may cause severe visual loss. The clinical picture is usually characterised by severe pain, sometimes disproportionate to the signs, with an early superficial keratitis that is often misdiagnosed as herpes simplex virus (HSV) keratitis. Advanced stages of the infection are usually characterised by central corneal epithelial loss and marked stromal opacification with subsequent loss of vision. In this paper, six cases of contact lens‐related Acanthamoeba keratitis that occurred in Australia and New Zealand over a three‐year period are described. Three of the patients were disposable soft lens wearers, two were hybrid lens wearers and one was a rigid gas permeable lens wearer. For all six cases, the risk factors for Acanthamoeba keratitis were contact lens wear with inappropriate or ineffective lens maintenance and exposure of the contact lenses to tap or other sources of water. All six patients responded well to medical therapy that involved topical use of appropriate therapeutic agents, most commonly polyhexamethylene biguanide and propamidine isethionate, although two of the patients also subsequently underwent deep lamellar keratoplasty due to residual corneal surface irregularity and stromal scarring. Despite the significant advances that have been made in the medical therapy of Acanthamoeba keratitis over the past 10 years, prevention remains the best treatment and patients who wear contact lenses must be thoroughly educated about the proper use and care of the lenses. In particular, exposure of the contact lenses to tap water or other sources of water should be avoided.     

Acanthamoeba keratitis related to cosmetic contact lenses

We report a rare case of Acanthamoeba keratitis related to cosmetic contact lenses in both eyes. A 17-year-old girl with a history of wearing cosmetic contact lenses presented with keratitis. She purchased cosmetic contact lenses via the Internet, and followed a contact lens care system irregularly, occasionally using tap water. Cell culture was performed on samples collected from a corneal scraping, the contact lenses and the storage cases. The isolated organism was Acanthamoeba. The patient was treated with polyhexamethylene biguanide and chlorhexidine for 3 months, and recovered with normal visual acuity. Poor hygiene and insufficient disinfection may be major risk factors for Acanthameoba keratitis in cosmetic contact lens wearers. The cosmetic contact lens user should receive professional advice before accessing the lenses, and this must be communicated to the public.     

接触镜相关性角膜新生血管形成临床分析

目的 探讨软性接触镜（ＳＣＬ）相关笥角膜新生血管形成（ＣＮＶ）的流行这、临床表现、危险因素与预防措施。方法 对１９９５年７月～１９９７年６月验配ＳＣＬ的屈光不正患者ＣＮＶ发生情况进行回顾性分析。结果 配前检查时,重配者中,ＣＮＶ阳性者（〉０．６ｍｍ）占７．４％,多位于角膜上下部的浅基质层,症状轻微,其中５１．９％有长戴史,４８．２％有配适问题,７４．１％护理不当,无定期复查者,初配者中,０．４％有     

1g/L氟米龙滴眼液联合软性角膜接触镜治疗丝状角膜炎

目的：探讨1g/L氟米龙滴眼液联合软性角膜接触镜治疗丝状角膜炎的疗效。

方法：确诊丝状角膜炎患者30例45眼,随机分为治疗组16例23眼、对照组14例22眼。治疗组取出丝状物后配戴软性角膜接触镜,点糖皮质激素眼液(1g/L氟米龙滴眼液)和人工泪液(玻璃酸钠眼液); 对照组取出丝状物后仅使用人工泪液(玻璃酸钠眼液)点眼。随访3mo,比较两组疗效。

结果：治疗组患者临床治疗总有效率22眼(96%),明显高于对照组17眼(77%),差异有统计学意义(P=0.046),且发现未对眼压有明显影响。

结论：1g/L氟米龙联合软性角膜接触镜治疗丝状角膜炎有较好疗效。