生物工程角膜移植治疗感染性角膜炎

目的：观察生物工程角膜移植治疗感染性角膜炎的疗效,评价其临床应用价值和意义。

方法：对我院35例35眼需要进行手术治疗的感染性角膜炎患者分为3组：观察组15例,使用生物工程角膜施行板层角膜移植手术。对照组有两组：对照1组10例,使用保存人角膜施行板层角膜移植手术; 对照2组10例,实施自体结膜瓣遮盖手术。随访3～20mo,观察视力、感染控制情况以及角膜透明度。

结果：观察组15眼术后感染控制,视力不同程度提高,除1眼在随访中发生植片混浊外,其余14眼植片均维持基本透明。对照1组,除1眼病毒性角膜炎因病毒复发导致角膜混浊外,其余9眼角膜植片维持透明。对照2组,除1眼真菌性角膜溃疡感染加重,行眼内容物剜除术,其余角膜溃疡瘢痕修复。

结论：生物工程角膜是一种新型的人角膜替代材料,为解决逐年增长的角膜病患者与短缺的角膜供体之间的矛盾发挥了作用。     

深板层角膜移植术治疗感染性角膜炎的效果

目的:评价深板层角膜移植术治疗感染性角膜炎的效果。方法:回顾性分析2017年8月至2019年10月济南市第二人民医院感染性角膜炎64例(64只眼)的临床资料,根据手术方式分为2组,其中深板层角膜移植术(DALK)31例(31只眼)作为观察组;穿透性角膜移植术(PKP)33例(33只眼)作为对照组。术后随访1年,比较两组...     

角膜移植治疗真菌性角膜炎180例临床分析

目的　探讨角膜移植术治疗真菌性角膜炎的临床效果。方法　对临床确诊的 180例 (180只眼 )真菌性角膜炎患者 ,32例行部分板层角膜移植术 (L KP) ,14 8例行穿透性角膜移植术 (PKP)。结果　 172例 (172只眼 )感染控制 ,治愈率为 95 .5 5 %。随访 2～ 2 4个月 ,32例 L KP患者 2 8例植片透明 ,矫正视力 0 .2～ 0 .8,10 9例 PKP患者植片透明 ,矫正视力 0 .0 5～ 1.0 ,两组病例矫正视力比较 ,无显著性差异 (P >0 .0 5 )。 PKP术后的并发症发生率明显高于 L KP。结论　角膜移植术是治疗真菌性角膜炎的有效方法 ,表浅型真菌性角膜炎 L KP术是可行的 ,且并发症少     

2004至2011年感染性角膜炎行角膜移植手术的适应证及手术方式变化趋势的研究

目的探讨近8年山东省眼科医院感染性角膜炎行角膜移植术的手术适应证和手术方式,并比较前4年与后4年手术适应证及手术方式的变化趋势。方法对2004年1月至2011年12月山东省眼科医院因感染性角膜炎行角膜移植术的患者761例(784只眼)资料进行回顾性调查。结果前4年感染性角膜炎的病因以真菌最为常见,其次为病毒、细菌、棘阿米巴。后4年也以真菌最为常见,其次为细菌、病毒、棘阿米巴。前4年角膜移植手术方式以常规穿透性角膜移植术(PKP)最为常见,其次为常规板层角膜移植术(LKP)、小植片偏中心PKP、深板层角膜移植术(DLKP)。后4年以常规LKP最为常见,其次为常规PKP、小植片偏中心PKP、DLKP。感染性角膜炎角膜移植手术适应证和手术方式的构成比变化在2个时间段差异均有统计学意义。结论真菌性角膜炎在感染性角膜炎患者中居首位,并有上升趋势。常规LKP所占的构成比持续增加,已成为感染性角膜炎首位的手术方式。DLKP及小直径偏中心PKP近几年来明显增加,成为角膜移植手术新的发展趋势。     

感染性角膜炎的角膜移植术

目的 评价感染性角膜炎角膜移植治疗的临床效果.方法 采用深板层或穿透性角膜移植治疗真菌性角膜溃疡97例(97眼),病毒性伯膜炎21例(21眼),棘阿米巴性角膜炎3例(3眼),共121例(121眼).临床观察2～20月.结果 119眼角膜植片存活,治愈率98.35%;2例复发,复发率1.65%.结论 对药物治疗无效的感染性角膜炎及时行治疗性角膜移植术,是控制感染,挽救眼球,甚至恢复有用视力的有效方法.     

生物人工角膜治疗感染性角膜炎的安全性和有效性

目的评价使用生物人工角膜行深板层角膜移植治疗感染性角膜炎的安全性和有效性。方法前瞻性临床研究。2013年12月至2014年11月温州医科大学附属眼视光医院诊治的感染性角膜炎患者20例（20眼）,使用生物人工角膜行深板层角膜移植术治疗。观察指标包括最佳矫正视力（BCVA）、生物人工角膜透明性、眼前节表现及并发症等,随访时间为6个月。疗效指标包括术后单眼的脱盲率和感染控制率。视力比较采用重复测量的方差分析,角膜透明性比较采用相关样本秩和检验。结果术后患者视力逐渐提高（F=94.97,P<0.01）,术后6个月视力（logMAR）为0.44±0.26,较术前（2.08±0.35）显著提高,差异有统计学意义（P<0.01）。术后1周角膜水肿逐渐消退,角膜植片逐渐透明,术后1个月完全透明（χ²=66.34,P<0.01）。随访期内出现1例原发病复发,1例角膜基质排斥。术后6个月随访时,单眼脱盲率为19/19,感染控制率为19/20。结论生物人工角膜行深板层角膜移植不仅可有效地控制细菌性、真菌性、病毒性角膜炎患者的原发感染,而且术后视力提高显著。     

感染性角膜炎的规范化诊断及治疗

感染性角膜炎是我国角膜病致盲的首位因素,要求医生遵循规范化的感染性病因学诊断方法,在了解感染病因学的前提下,明确感染性角膜炎在何种情况下应进行药物治疗,在疾病的什么阶段应采取手术治疗,并明确各种手术的适应证.     

利用猪角膜脱细胞基质行板层角膜移植手术治疗感染性角膜炎的临床研究

目的 评价利用猪角膜脱细胞基质行板层角膜移植手术治疗感染性角膜炎的安全性和有效性.方法 采用前瞻性系列病例观察研究方法,纳入了2018年5月～2019年4月本院收治的感染性角膜炎15例(15眼),使用猪角膜脱细胞基质行板层角膜移植手术.观察指标主要包括感染控制情况、角膜透明度、新生血管形成、最佳矫正视力(BCVA)及并...     

微生物混合感染性角膜炎动物模型研究进展

微生物混合感染性角膜炎是一种因角膜感染,严重时会致盲的眼表疾病,起病急、发展迅速,严重时会引起角膜穿孔,可致视力下降或视力丧失。建立微生物混合感染性角膜炎动物模型有利于探索其发病机制、预防、临床诊断和治疗等。本文对微生物混合感染性角膜炎动物模型的制作方法及造模感染成功后的鉴定方法进行综述,旨在为进一步开发、研究该病的动物模型提供参考。     

多元化治疗252例真菌性角膜炎的临床分析

目的真菌性角膜炎发病率高,临床上因缺乏高效、低毒和广谱的抗真菌药物且角膜供体缺乏,治疗较为棘手。寻求经济、有效地治疗方法具有重要临床意义。方法临床病例前瞻性研究。收集2013年1月至2014年1月期间于河南省眼科研究所门诊就诊的真菌性角膜炎患者252例252只眼,先行药物治疗2—3周后,对药物治疗无效者根据病灶范围及深度分别采用病灶切除联合羊膜覆盖术、病灶切除联合结膜瓣覆盖术、板层角膜移植术及穿透角膜移植术治疗,随访至临床治愈后3个月。结果252例患者均为单眼发病,有明确植物外伤史者136例,其他外伤史42例。真菌培养阳性者168例,真菌培养阳性率为66．7％。其中药物治疗痊愈者153例,行病灶切除羊膜覆盖术者12例,病灶切除结膜瓣覆盖术17例,板层角膜移植术15例,真菌感染复发2例,穿透角膜移植20例,真菌感染复发2例。治疗后平均视力较治疗前有一定程度改善,差异有统计学意义（P〈0．05）。临床治疗总有效率为90．25％。所有感染菌种中,曲霉菌角膜炎临床治疗效果不佳（P〈0．05）。结论真菌性角膜炎早期采用多种抗真菌药物联合频繁点眼,可取得较好效果。确诊后应根据病情、病程及现有医疗条件制定多元化治疗方案,提高临床治愈率,改善预后视力。     

Infectious keratitis after lamellar keratoplasty

Infectious keratitis after lamellar keratoplasty is a potentially devastating complication that may severely limit the visual and anatomical outcomes. The deep-seated location of the infiltrates, sequestration of the pathogenic microorganisms and limited penetration of the currently available antimicrobial agents often results in delayed diagnosis that may jeopardize the management in these cases. Fungal keratitis is more common as compared with bacterial or viral keratitis and classically presents as white interface infiltrates that may not be associated with significant inflammation. Confocal microscopy may help to establish a rapid diagnosis in such cases, and anterior segment optical coherence tomography may be used to determine the extent of infection and monitor its progression. Conservative measures such as topical antimicrobials and interface irrigation with antimicrobial agents may be done. Surgical intervention in the form of partial excision/removal of the graft in endothelial keratoplasty or a full-thickness keratoplasty is often required for the effective management of deep-seated infections. Timely diagnosis and intervention may result in complete resolution of infection in both anterior lamellar and endothelial keratoplasty. Infections after anterior lamellar keratoplasty have a fair prognosis, and a clear graft with functional visual acuity may be achieved in most cases. By contrast, infections after endothelial keratoplasty have a guarded prognosis, and the presence of concomitant endophthalmitis may further complicate the graft survival and visual outcomes.     

A surgical alternative of fusiform penetrating keratoplasty for the management of severe infectious keratitis

AIM: To describe the surgical procedure of fusiform penetrating keratoplasty (FPK) using multiple trephines of different sizes for treating patients with severe infectious keratitis. METHODS: Fourteen eyes underwent FPK, and 15 eyes received conventional penetrating keratoplasty (PK) were included in the study. The best-corrected visual acuity (BCVA), refractive outcomes, endothelial cell density, and postoperative complications were recorded. RESULTS: The FPK group was followed for an average of 15.3±2.1mo, whereas the PK group was followed for 16.1±1.9mo. The corneal ulcers were elliptical-shaped in all 14 eyes in the FPK group. The mean BCVA (logMAR, 0.26±0.13) showed no statistically significant differences from that in the PK group (logMAR, 0.21±0.12, P>0.05) at 1y after surgery. But the mean curvature, mean astigmatism, and mean spherical equivalent in the FPK group were lower than those in the PK group (P<0.05). Peripheral anterior synechia was observed in one patient in the FPK group, whereas 6 patients in the PK group. Suture loosening and neovascularization were observed in 4 and 5 eyes in the PK group, respectively. No graft immune rejection or elevation of intraocular pressure was observed in the two groups. CONCLUSION: For patients with elliptical-shaped corneas or corneal ulcers, FPK can avoid disrupting of corneal limbus, reduce the risk of postoperative complications, and can result in satisfactory visual quality.     

First aid for complications of infectious keratitis

Infectious keratitis is a fairly common entity in India. However while paying attention to the primary entity, the associated events may be overlooked. Enhanced pain usually suggests a worsening of the condition or development of associated problems like secondary glaucoma. However, contrary to logic, a sudden decrease in pain is also likely to suggest a worsening, e.g. perforation of the corneal ulcer. Various such problems with their management are outlined.     

穿透性角膜移植术治疗坏死性基质角膜炎23例

目的:探讨穿透性角膜移植术(penetratingkeratoplasty,PKP)治疗坏死性基质角膜炎(necrotizingstromalkeratitis)的手术适应证及其临床效果。方法:按照Holland等的HSK新分类法,选择确诊坏死性基质角膜炎患者,予以局部及全身药物治疗。对病情不能控制,药物治疗无效的患者22例(23眼),其中角膜溶解穿孔3眼,用新鲜角膜组织行穿透性角膜移植术,并随访观察术后疗效。结果:随访3mo～3a,22例(23眼)中,术后视力提高者18眼,其中矫正视力达到0.1～0.5者12眼,0.05～0.1者6眼;无改善者5眼。角膜植片透明17眼,半透明2眼,植片混浊4眼,植片透明率为74%。术后3眼植片发生排斥反应,3眼原发病灶复发。2眼术后因排斥反应及原发病灶反复发作,植片完全混浊,行2次角膜移植术。结论:对坏死性基质角膜炎患者,药物保守治疗无效、角膜坏死穿孔或行将穿孔,及时用新鲜角膜组织行穿透性角膜移植术治疗,不仅能控制炎症,缩短病程,而且能保存眼球,恢复部分视力,因此具有重要临床应用价值。     

放线菌性角膜炎5例临床分析

目的分析总结放线菌性角膜炎的诊断及治疗方法。设计回顾性病例系列。研究对象5例（5眼）放线菌性角膜炎患者。方法回顾性分析2004年10月至2006年3月间明确诊断的5例放线菌性角膜炎患者的临床表现，实验室菌种鉴定及药物敏感性试验。主要指标临床特征、菌种鉴定、药敏分析。结果5例放线菌性角膜炎患者均为男性、农民，其中4例发病前有“迷眼”一角膜擦伤史，为该病主要危险因素，临床主要表现为慢性进行性角膜浅、中基质层溃疡，实验室检查明确诊断为奴卡菌性角膜炎4例，另1例为链霉菌感染。药敏试验显示阿米卡星、复方新诺明、庆大霉素及氟喹诺酮类为主要敏感抗生素，抗生素敏感性差异较大。治疗主要采用敏感抗生素频繁点眼联合局部清创、5％碘酊烧灼，2例溃疡较深者予病灶切除联合羊膜覆盖术。结论放线菌性角膜炎多有“角膜擦伤”史，角膜刮片细胞学及细菌学检查可辅助明确诊断。对中重度患者强调药物、清创及手术相结合的综合治疗。     

真菌性角膜炎临床转归与病理分析

目的探讨如何通过术前检查更合理地指导真菌性角膜炎手术治疗方式的选择,分析影响真菌性角膜炎预后的因素。方法回顾性分析真菌性角膜炎患者31例,观察分析临床特点、激光角膜共焦显微镜检查图像、治疗过程、病理检查结果、临床转归情况。将所有共焦深度、临床特点、病理检查资料采用SPSS17.0软件包完成统计学分析。结果共焦深度为(202.58±150.65)μm,病理深度(261.29±150.95)μm;水平生长22例,垂直生长9例。Kappa检验示共焦深度与病理深度的一致性较好(P=0.000);临床特点中,前房积脓与共焦深度存在线性回归关系(P<0.05);Logistic回归分析示前房积脓与病理形态存在回归关系(OR=4.047,P=0.016);前房积脓、共焦深度、病理形态3个指标与真菌性角膜溃疡预后有相关性(均为P<0.05)。结论临床医师可通过对真菌性角膜溃疡的临床、共焦显微镜检查来帮助推测真菌生长形态,进而判断预后以及是否可行板层角膜移植术。     

Medical management approach to infectious keratitis

This section provides guidelines on medical therapy of patients with infectious keratitis. In addition to initial empirical therapy, preferred medications, once the organisms responsible are isolated, are discussed. Atypical mycobacterial keratitis following lasik is described. General guidelines for supportive therapy and follow-up, of these patients are presented. Clinical response to treatment and indications for intervention are discussed. Possible causes and approach to cases refractory to medical therapy are discussed.     

棘阿米巴性角膜炎的手术治疗

目的：回顾性分析20例棘阿米巴性角膜溃疡行角膜移植术的疗效，确定其手术适应证及手术疗效。方法：20例患者中男性12例，女性8例，年龄13～46岁。病因为戴角膜塑型镜(OK镜)者10例，戴接触镜者6例，角膜外伤者4例。手术指征及手术方法：临床药物治疗无效，且角膜病变区逐渐扩大并加深，有穿孔危险者。20例患者中17例采用板层角膜移植术，3例因病变较深而行穿透角膜移植术。术后患者仍局部滴用抗阿米巴药物1～3个月。结果：20例患者角膜病变均得到控制。5例患者术后再次行穿透角膜移植术，术后裸眼视力为0．3～0．6。8例板层植片透明者视力为0．05～0．4。未行穿透角膜移植术者，由于板层植片大量新生血管长人，需再次行板层角膜移植术联合角膜缘干细胞移植术。结论：棘阿米巴性角膜溃疡药物治疗疗程长，难购药品，容易延误病情。对病变难以控制者，手术治疗为其有效的治疗方法。     

Investigative modalities in infectious keratitis

Standard recommended guidelines for diagnosis of infectious keratitis do exist. Based on an extensive Medline literature search, the various investigative modalities available for aiding the diagnosis of microbial keratitis have been reviewed and described briefly. Preferred practice patterns have been outlined and the importance of routine pre-treatment cultures in the primary management of infectious keratitis has been highlighted. Corneal scraping, tear samples and corneal biopsy are few of the specimens needed to carry out the investigative procedures for diagnosis and for initiating therapy in cases of microbial keratitis. In bacterial, fungal and amoebic keratitis, microscopic examination of smears is essential for rapid diagnosis. Potassium hydroxide (KOH) wet mount, Gram's stain and Giemsa stain are widely used and are important for clinicians to start empirical therapy before microbial culture results are available. The usefulness of performing corneal cultures in all cases of suspected infectious keratitis has been well established. In cases of suspected viral keratitis, therapy can be initiated on clinical judgment alone. If a viral culture is needed, scrapings should directly be inoculated into the viral transport media. In vivo confocal microscopy is a useful adjunct to slit lamp bio-microscopy for supplementing diagnosis in most cases and establishing early diagnosis in many cases of non-responding fungal and amoebic keratitis. This is a non-invasive, high resolution technique which allows rapid detection of Acanthamoeba cysts and trophozoites and fungal hyphae in the cornea long before laboratory cultures give conclusive results. Other new modalities for detection of microbial keratitis include molecular diagnostic techniques like polymerase chain reaction, and genetic finger printing by pulsed field gel electrophoresis.