利用共焦激光角膜显微镜诊断真菌性角膜炎

<正>共焦激光角膜显微镜是一种新型、无创伤性的角膜影像学检查仪器,我院在国内率先引进了德国海德堡公司研制的HRT-Ⅱ共焦激光角膜显微镜,并对真菌性角膜炎的早期诊断作了探索,现报告如下。     

真菌性角膜炎常规与共焦显微镜检查诊断的对比

真菌性角膜炎是一种致盲率非常高的感染性角膜疾病,为真菌直接侵入角膜所致.通常因外源性感染、眼附属器感染的蔓延及内源性感染所致,眼科常见的致病性真菌达数十种,其中以丝状真菌(包括镰刀菌、曲霉菌及青霉菌等)和酵母菌(白色念珠菌)多见,感染后常引起角膜溃疡或穿孔,治疗不当可导致失明[1].     

激光共焦显微镜观察真菌性角膜炎治疗效果的研究

目的 研究激光共焦显微镜对观察真菌性角膜炎治疗过程中病情转归的意义.方法 对42例(42眼)经门诊诊断为真菌性角膜炎的患眼,临床使用那他霉素眼用混悬液抗真菌治疗,治疗前及治疗后l周、1月分别行患眼的激光共焦显微镜检查,观察真菌菌丝生长情况.并根据临床反应判断治疗结果.结果 治疗后病灶处菌丝密度明显减少,甚至消失,周边炎性细胞浸润减少,基质透亮度增加,胶原纤维增生,组织呈瘢痕化增生.治疗前,激光共焦显微镜下42例中37例见菌丝分布(88.1％),抗真菌治疗l周后42例菌丝阳性为26例(61.9％),1月后患眼菌丝阳性为9例(21.4％),结果差异具有统计学意义(P＜0.05).最终治愈28例(66.7％),好转9例(21.4％),无效5例(11.9％).最终有效率达88.1％.其中无效5例中均为菌丝阳性,好转中菌丝阳性为4例,但密度较治疗前明显减少.结论 激光共焦显微镜对观察真菌性角膜炎病情的转归具有临床意义.     

心理护理干预在真菌性角膜炎患者共聚焦显微镜检查中的应用研究

目的 心理护理干预在真菌性角膜炎患者共聚焦显微镜检查中的应用效果.方法 选择合适的患者60例,随机分为观察组和对照组各30例,观察组实施心理护理干预,对照组采用传统护理模式,比较两组患者焦虑及生命体征变化.结果 两组患者检查预约时HAMA-14量表评分相似,差异无统计学意义（P＞0.05）;观察组检查开始时和检查结束时HAMA-14量表评分均低于对照组,差异存在显著性（P＜0.05）.对照组检查预约时、检查开始时和检查结束时HAMA-14量表评分均相似,差异无统计学意义（P＞0.05）;观察组检查开始时和检查结束时HAMA-14量表评分低于检查预约时,差异存在显著性（P＜0.05）.两组患者检查预约时血压及心率相似,差异无统计学意义（P＞0.05）;观察组检查开始时和检查结束时血压及心率均优于对照组,差异存在显著性（P＜0.05）.观察组患者检查预约时、检查开始时和检查结束时血压及心率均相似,差异无统计学意义（P＞0.05）;对照组检查开始时和检查结束时血压及心率高于检查预约时,差异存在显著性（P＜0.05）.结论 真菌性角膜炎患者共聚焦显微镜检查过程中实施心理护理干预,可以有效减轻患者的焦虑,保持生命体征平稳,保证检查的顺利进行.     

实验室检查在真菌性角膜炎诊治中的作用

真菌性角膜炎是一种严重的致盲性眼病,近年来随着全身、局部应用大量抗生素及皮质类固醇激素导致局部免疫低下及菌群失调所致的条件致病真     

共聚焦显微镜在感染性角膜炎中的应用研究进展

对于感染性角膜炎患者而言,尽早明确诊断对治疗该病至关重要.共聚焦显微镜具有高放大率的特征,在活体角膜中能观察体积小至微米级的微生物,具备对活体细胞进行非侵入性、动态观察的优势.感染性角膜炎根据不同病原体分为不同类型,而不同类型感染性角膜炎的临床特点及诊疗具有差异.近年来,为明确引起感染性角膜炎的病原体、观察病灶范围及深...     

探讨结膜移盖在真菌性角膜炎治疗中的临床效果

目的:研究分析真菌性角膜炎患者接受结膜移盖治疗的临床效果。方法:根据我院2006年9月至2007年9月的60例真菌性角膜炎患者来分析,将患者分成AB两组,A组使用单纯药物治疗,B组使用结膜移盖治疗,比较分析两组的临床治疗效果。结果:A组有19例患者被治愈,2例失访,3例化脓性眼内炎。6例角膜穿孔后行穿透性角膜移植术。B组有27例被治愈,3例失访,8例结膜移盖脱落二次三次手术。B组的炎症控制和角膜透明性比A组高。结论:真菌性角膜炎患者接受结膜移盖治疗的临床成功率比较高,效果好。     

18例真菌性角膜炎临床诊治探讨

目的探讨真菌性角膜炎的临床表现、诊断及治疗措施。方法选择近年来收治的真菌性角膜炎患者18例,所有患者早期均行局部清创、碘酊烧灼、生理盐水冲洗后,给予氟康唑1ml作结膜下注射;同时口服伊曲康唑0．2g,1次／d,并辅助给予贝复舒眼液,口服多种维生素治疗,疗程14～42d。结果本组18例中治愈17例,占94．4％;好转1例,总有效率达100％。1例出现一过性刺激症状,其他患者未出现明显不良反应。结论真菌性角膜炎是一种致盲性较高的眼病,早期诊断及有效的抗真菌治疗,是保护眼球、抢救视力的关键,早期及时给予有效治疗,绝大多数轻症真菌性角膜炎患者可治愈。     

苏木素在真菌性角膜炎诊断中的应用

目的研究苏木素在真菌性角膜炎早期诊断中的价值。方法 2006年6月至2011年6月期间临床诊断为真菌性角膜炎病例59例,角膜刮片,标本分别行苏木素染色、KOH湿片检查和真菌培养。以培养结果做为确诊真菌性角膜炎的"金标准"。结果 59例真菌性角膜炎病例中47例检出真菌,阳性率79.66%。苏木素染色法查找真菌阳性率64.40%,灵敏度74.46%,特异度42.86%,假阳性率25.00%,假阴性率25.53%,正确指数17.32%,阳性预测值92.11%,阴性预测值42.85%。KOH湿片法查找真菌阳性率45.76%,灵敏度44.68%,特异度18.75%,假阳性率50.00%,假阴性率55.32%,正确指数-36.57%,阳性预测值77.78%,阴性预测值18.75%。结论苏木素染色法是真菌性角膜炎早期诊断的快速、有效方法。     

浅谈真菌性角膜炎的药物治疗临床分析

目的 回顾性总结真菌性角膜溃疡的有效药物治疗的临床表现、病程及治愈率。方法30例（32只眼）患者真菌性角膜溃疡临床表现符合诊断标准。治疗上采用抗生素，如庆大霉素结膜下注射，同时用抗生素及抗真菌剂滴眼（1％5-氟胞嘧啶和0．1～0．3％两性霉素B），加强散瞳治疗。急性期在肝功能正常情况下，可口服抗真菌药（酮康唑）1～3疗程；多种维生素族药物口服，坚持全疗程；2．5％碘酊小病灶早期烧灼，或大病灶的中晚期烧灼，一般不超过3次。结果30例（32只眼）经药物治疗，其中21只眼3～10周溃疡治愈，其余11只眼疗程为3～5个月。合并症病例因病灶穿孔后新生血管深入而愈合。结论真菌性角膜溃疡。早期诊断，早期合理用药是治愈的关键。小病灶、表浅者用抗真菌剂并及时病灶烧灼效果肯定，预后留有浅层斑翳；治疗期均禁用激素，病灶愈合后仍应巩固用药1月以上。     

特比萘酚联合氟康唑治疗真菌性角膜炎的效果分析

目的研究特比萘酚联合氟康唑治疗真菌性角膜炎的效果。方法选取本院2009年6月～2011年2月收治的52例真菌性角膜炎患者,随机分为对照组与治疗组,每组各26例。对照组使用氟康唑进行治疗,治疗组使用氟康唑联合特比萘酚进行治疗。结果治疗组的有效率为92．3％,明显高丁对照组的80．8％,治疗组的治愈天数为（36．19±13．18）d明显短于治疗组的（23．75±12．92）d;两组的不良反应比较,后异有统计学意义（P〈0.01）。结论特比萘酚联合氟康唑治疗真菌性角膜炎的治疗效果较好,值得临床推广应用。     

Assessment safety and efficacy of a combination therapy of topical amphotericin B and subconjunctival fluconazole for the treatment of fungal keratitis

Purpose: The study was aimed at evaluating the treatment of fungal keratitis using a combination therapy of a low concentration of topical amphotericin B (0.2?mg/mL) eye drops together with subconjunctival injections of 2?mg/mL of fluconazole.

Methods: The study was carried out in the Ophthalmology Department of Zagazig University Hospital and included 12 patients with 12 pairs of eyes with resistant corneal ulcers that had the following clinical features suggesting fungal keratitis: thick elevated ulcer, feathery edge, and gutter formation. Cultures of corneal specimens were grown on Sabouraud agar medium. Topical amphotericin B eye drops in a concentration of 0.2?mg/mL in dextrose 5% were used every 2 hours for 21 days together with subconjunctival injections of fluconazole 2?mg/mL.

Results: Among the eyes subjected to culture of corneal specimens, 8 eyes had positive results: Candida was detected in 5 eyes (66%) and filamentous fungi grew from the cultures of 3 eyes. Nine eyes improved as a result of treatment, showing complete healing of the ulcers (75%). Three cases showed no improvement (25%); 2 cases developed endophthalmitis; and 1 case was negative. A single case with corneal perforation had negative results on culture.

Conclusion: The use of a combination of topical amphotericin B eye drops at a concentration of 0.2?mg/mL in dextrose 5% with subconjunctival injection of fluconazole 2?mg/mL had the advantage of a lower incidence of the complications of local use of amphotericin B and a broader spectrum of antifungal coverage. This study reports a relatively high success rate of healing of fungal keratitis, with a significant reduction of the potential side effects of the local use of antifungal agents.     

角膜基质内注射伏立康唑治疗真菌性角膜炎的临床疗效及安全性观察

目的:评价角膜基质内注射伏立康唑治疗真菌性角膜炎的临床疗效和安全性。方法:选择角膜刮片或结膜囊涂片证实为真菌性角膜炎并常规治疗2周无效的患者19例(19眼)。于病灶区角膜基质内注射伏立康唑(50μg/0.1m L)。术后继续使用局部、口服抗真菌药物治疗,观察角膜情况及前房情况。结果:本组患者19例进行角膜基质内注射伏立康唑注射液,术后联合抗真菌滴眼液及全身药物治疗。3例患者(15.8%)角膜基质单次注药后好转,8例患者(42.1%)重复注药后好转。9例患者(47.4%)角膜基质注药后出院时视力明显提高,17例患者(89.5%)出院时角膜浸润面积减少,10例患者(83.3%)前房积脓减少或消失,2例患者(66.7%)角膜内皮斑显著减少。术后随访6月,未发现继发性眼内炎和青光眼等。结论:角膜基质内注射伏立康唑治疗真菌性角膜炎安全有效,短期内无明显并发症。     

Thermosensitive hydrogel containing sertaconazole loaded nanostructured lipid carriers for potential treatment of fungal keratitis

This study was conducted to develop an in situ thermosensitive gel containing sertaconazole-loaded nanostructured lipid carriers (NLCs) for prolonged ocular drug delivery. To this end, sertaconazole-loaded NLCs (sertaconazole-NLCs) were prepared by emulsification solvent-diffusion method and the effects of different formulation variables were assessed using the fractional factorial design. Then, optimized sertaconazole-NLCs were incorporated into the pluronic F127 (PF127)/hydroxy propylmethylcellulose (HPMC) K4M hydrogel. The formulations were examined for pH, gelation temperature, rheological properties, in vitro permeation studies, and anti-fungal activity. The optimized sertaconazole-NLCs showed a mean particle size of 272.40?nm, encapsulation efficiency of 89.97%, zeta potential of 12.9?mV, and polydispersity index of 0.31. All the in situ formulations had acceptable pH, ranging from 5.89 to 6.28. The gelation temperature of the optimized formulation was 35.1?°C after dilution with simulated tear fluid (STF). Sertaconazole-NLCs showed a higher antifungal activity and permeation through the bovine cornea compared to the free drug and the in situ gel formulation. The cornea penetration of sertaconazole for the in situ gel of NLCs was also comparable to that for free drug. The obtained results indicated that the prepared nanocomposite system may have potential for treatment of fungal keratitis.     

Laser scanning confocal fluorescence microscopy: an overview

Innovative and important aspects of laser scanning confocal fluorescence imaging (LSCFI) are presented here as a general overview. We have described and discussed the technology of the procedure in some detail. We also report some of our original work with transmembranous uptake of 5S gamma-globulin on living human leukocytes as an example of one specific application of LSCFI. These original data and results are presented, as well as citing other uses and applications, to show the power of LSCFI technique. The article will hopefully be useful for those not familiar with the methodology and utility of laser scanning confocal fluorescence microscopy. Applications of LSCFI are very diverse, and there are new applications of this technology constantly being developed. Interest is growing in LSCFI, particularly in the pharmacologic and therapeutic areas, as demonstrated in this article.     

那他霉素联合氟康唑治疗外伤后真菌性角膜炎的疗效观察

目的探讨5%那他霉素滴眼液联合0.2%氟康唑滴眼液和氟康唑注射液治疗外伤后真菌性角膜炎的临床疗效及预后情况。方法选取2011年6月—2015年6月重庆市长寿区人民医院收治入院的外伤后真菌性角膜炎患者180例为研究对象,按随机数字表法将患者分为对照组和治疗组,每组各90例。对照组给予0.2%氟康唑滴眼液1~2滴/次,角膜病变轻度者1次/h,中度及重度者1次/0.5 h,同时给予氟康唑注射液1 m L结膜下注射,1次/d。治疗组在对照组的基础上加用5%那他霉素滴眼液交替点眼1~2滴/次,1次/1 h。两组均治疗2~3周。观察两组的临床疗效,同时比较治疗前后两组患者的角膜炎严重程度评分、视力以及随访90 d的预后情况。结果对照组、治疗组患者总有效率分别为73.3%、88.9%,两组总有效率比较差异具有统计学意义(P0.05)。治疗后7、14 d,两组患者角膜炎严重程度评分显著降低,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标的降低程度优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后两组总体视力均明显改善,同组治疗前后差异具有统计学意义(P0.05);且治疗组总体视力改善情况优于对照组,两组比较差异有统计学意义(P0.05)。随访90 d,对照组、治疗组预后中等以上比率分别为85.5%、96.7%,两组预后中等以上比率比较差异具有统计学意义(P0.05)。结论 5%那他霉素滴眼液联合0.2%氟康唑滴眼液和氟康唑注射液治疗外伤后真菌性角膜炎具有较好的疗效,能够显著降低角膜炎严重程度评分,明显改善患者视力和预后水平,值得临床运用和推广。     

氟康唑与酮康唑对真菌性角膜溃疡的疗效对比探讨

目的：观察对氟氯唑和酮康唑治疗真菌性角膜溃疡的对照研究。探讨氟康唑治疗真菌性角膜溃疡的效果。方法：将真菌性角膜溃疡患者30例分为氟康唑组（n=16)和酮康唑组（n=14)，比较组间的治愈率和平均疗程。结果：氟康唑组治愈率为93．8％，平均疗程17．5d。酮康唑组治愈率仅为57．1％，平均疗程34．5d。且间治愈率和平均疗程的比较均具有统计学意义（P＜0．05）。结论：氟康唑组的治愈率和平均疗程均明显优于酮康唑组。