羊膜应用于眼表疾病的临床分析

目的探讨羊膜在眼表疾病中应用的适应证及效果。方法回顾2006年5月至2009年5月在我院行羊膜治疗的病例,分析其原发病、手术方式及治疗效果。结果羊膜治疗的患者共81例（87眼）。其中羊膜覆盖术（覆盖全角膜或全部眼球表面）35例（39眼）,羊膜移植术（移植于角膜病灶区）13例（15眼）,羊膜移植联合羊膜覆盖术31例（31眼）,羊膜充填术（填补角膜缺损）2例（2眼）。羊膜覆盖术患者的原发病为单纯疱疹病毒性角膜炎（上皮型）、角膜上皮缺损、化学伤、暴露性角膜炎、神经源性角膜炎及大泡性角膜病变。羊膜移植患者的原发病为睑球粘连、假性胬肉及义眼台脱出;羊膜移植联合羊膜覆盖术患者的原发病为真菌性角膜炎、单纯疱疹病毒性角膜炎（混合型）、细菌性角膜炎、睑球粘连、假性胬肉及蚕蚀性角膜溃疡。羊膜充填术的原发病为角膜穿孔伤。羊膜治疗后均未见免疫排斥现象。结论羊膜具有良好的组织相容性和低免疫原性,可广泛应用于眼表疾病的冶疗。     

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。     

小鼠角膜抑制白念珠菌增生机制的探讨

真菌性角膜炎（fungal keratitis，FK）是严重危害视力的感染性角膜病。近年来随着抗生素、糖皮质激素等免疫抑制剂及化疗药物的广泛应用，眼部真菌感染的发病率在我国有逐年增多的趋势，已成为我国重要的致盲性眼病。研究FK发病机制时发现，实验性白念珠菌性角膜炎无需治疗就可以痊愈，其中感染引起的特异性免疫反应发挥着重要作用[1]。     

棘阿米巴性角膜炎的发病相关因素

由于角膜接触镜的日益广泛使用,棘阿米巴性角膜炎在世界范围内呈上升趋势。本文就棘阿米巴性角膜炎发病相关因素包括人口学特征（性别、年龄、职业）、季节倾向和地理分布特征以及易感危险因素（角膜接触镜佩戴、眼部创伤、眼部手术、并存眼部疾病或混合感染）的研究进展进行综述。（国际眼科纵览,2020, 45：393-396）     

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。     

眼内手术后病毒性角膜炎临床分析

目的:回顾分析了2007/2009年3a间眼内手术后患病毒性角膜炎患者的病例资料,对其发生发展的原因进行总结归纳并分析探讨。方法:收集眼内手术后发生病毒性角膜炎患者30例,白内障并人工晶状体植入术后18例,玻璃体切除术后9例,青光眼术后3例。对其病史,角膜炎发作时间,发病时症状,眼部查体以及诊治经过进行分析总结。结果:患者30例中18例有病毒性角膜炎或重度病毒性结膜炎感染史,6例患者有感冒或消化道疾病等诱因,30例患者均有不同程度的刺激症状,查体角膜点状侵润或树枝状混浊。应用抗病毒药物和营养角膜药物后治愈。结论:眼内术后发生病毒性角膜炎跟病毒性角结膜炎感染史,机体免疫力低下,破坏泪膜稳定性,损伤角膜内皮,术后大剂量激素用药等密切相关。及时发现和及早治疗是防治关键。     

角膜移植术后植片继发真菌感染的临床特征

目的探讨角膜移植术后植片继发真菌感染的原发病、发病时间、临床特征、主要致病菌及治疗方案的选择。方法回顾性系列病例研究。收集2005年10月至2016年1月间山东省眼科研究所青岛眼科医院收治的角膜移植术后植片发生真菌感染患者29例（34眼）,其中男25例（86%）,女4例（14%）。分析患者原发病、植片真菌感染与角膜移植间隔时间、发病月份、诱发因素、病灶特征、致病菌及治疗情况。数据采用配对秩和检验进行分析。结果发生角膜植片真菌感染的34眼中,25眼（74%）既往接受过穿透性角膜移植术（PKP）,9眼（26%）接受板层角膜移植术（LKP）。术前原发病大多为感染性角膜炎（24眼,70%）。植片发生真菌感染与角膜移植间隔时间为1~144个月,平均（39.5±43.0）个月,其中9眼（26%）发生于术后6个月内,3眼（9%）发生于6~12个月。植片真菌感染发生时间多在9-11月（17眼,50%）。27眼（79%）真菌培养结果阳性,致病菌主要为镰刀菌（9眼,33%）和链格孢霉菌（6眼,22%）。29眼（85%）真菌感染灶局限于角膜植片,5眼（15%）同时累及角膜植片和植床。22眼（65%）位于植片中央及旁中央区,其中15眼病灶直径＞4 mm,7眼≤4 mm;12眼（35%）位于植片周边区,病灶长径均＜4 mm。27眼选择药物联合手术治疗,4眼选择单纯药物治疗,3眼放弃治疗,自动出院。角膜移植术是最主要的手术治疗方式（16眼,59%）,其次是眼内容剜除术或眼球摘除术（6眼,22%）。结论角膜移植术后植片真菌感染多发生于秋季农忙季节。致病菌以镰刀菌和链格孢霉菌为主。角膜移植术是治疗植片继发真菌感染的主要手术方式。早期诊断并及时治疗,可最大限度地降低角膜植片真菌感染对视功能的影响。     

13例硬皮病眼部表现临床分析

目的 探讨硬皮病有眼部表现患者的临床特点。设计 回顾性病例系列。研究对象 2008年12月至2013年2月北京同仁医院风湿免疫科住院的13例伴眼部受累硬皮病患者。方法 回顾性分析13例累及眼部的硬皮病患者的临床资料,总结该病临床及实验室特点。主要指标 硬皮病患者的各种眼部表现占总病例数的百分比。结果 13例硬皮病患者均为女性;眼部受累的平均发病年龄为（43±12.2）岁,硬皮病平均病程（6.1±5.1）年,眼病平均病程（1.4±1.9）年。系统型硬皮病11例（84.6%）;局限型硬皮病2例（15.4%）。以眼部症状为首发表现者7例（53.8%）。干燥性角结膜炎7例（53.8%）,眼睑皮肤改变3例（23.1%）和青光眼3例（23.1%）为常见眼部表现;其他表现依次为视神经炎、角膜炎、虹睫炎（各2例,占15.4%）,巩膜炎、白内障、葡萄膜炎、中心性浆液性脉络膜视网膜病变、眼球内陷、泪腺炎（各1例,占7.7%)。未发现眼部受累与全身表现及实验室指标相关。结论 各型硬皮病均可出现眼部受累,其中以系统型硬皮病为主。硬皮病眼部表现多样,受累范围广泛,其中以干燥性角结膜炎最常见。（眼科, 2015, 24： 317-319, 360）     

细菌性角膜溃疡误诊原因及预后分析

目的研究细菌性角膜溃疡的特点,分析引起误诊的原因,探讨影响患者预后的相关因素。方法回顾性分析。以2011年1月至2013年12月间山东省眼科医院收治的83例(83只眼)确诊为细菌性角膜溃疡的患者作为研究对象。通过统计患者误诊疾病、发病诱因、眼部临床表现、就诊医院、所行辅助检查等,分析误诊原因。通过统计不同确诊时间的患者药物、手术治疗的情况,分析误诊患者确诊前病程与其预后的关系。结果 83例患者的发病诱因中49例有各种角膜外伤史,包括植物性外伤22例(占26.5%)。42例患者眼部临床表现为病史迁延、病灶边界不清,伴类似伪足或类似卫星灶、类似内皮斑等。33例患者于首诊医院误诊,误诊疾病分别为真菌性角膜炎28例(占33.7%)、病毒性角膜炎5例(占6.0%)。首诊医院为省市级医院的误诊率为29.3%,县级及以下医院的误诊率为50.0%。省市级医院行角膜刮片及培养者占70.7%,刮片阳性率27.6%。县级及以下医院行实验室检查者仅占30.1%,刮片阳性率15.4%。预后:误诊患者中确诊前病程≤2周者药物治愈6例(占30.0%),行角膜病灶切除治愈4例(占20.0%),行角膜移植治愈10例(50.0%),总治愈率100%。病程大于2周者,药物治愈2例(占15.4%),行角膜病灶切除治愈3例(占23.1%),行角膜移植治愈6例(46.1%),行眼内容剜除2例(占15.4%),总治愈率84.6%。结论目前细菌性角膜溃疡的误诊率仍较高,普及严格、规范的实验室检测结合其他辅助检查能有效降低误诊率。早确诊、早治疗有助于改善误诊患者预后。     

1997至2002年山东省眼科研究所穿透性角膜移植术的原因分析

目的 探讨1997至2002年山东省眼科研究所6年间行穿透性角膜移植术（PKP）的原因及其变化。方法 对1997年1月至2002年12月山东省眼科研究所的所有PKP病例进行回顾性调查,将PKP的原因分为10类：化脓性角膜炎、单纯疱疹病毒性角膜炎、圆锥角膜、大泡性角膜病变、角膜白斑、角膜破裂伤、角膜烧伤、再次PKP、遗传相关的角膜营养不良和角膜变性及其他。并且记录化脓性角膜炎的病原菌,大泡性角膜病变的病因,再次PKP的原发病和再次手术的原因。分析6年间PKP的原因及其变化情况。结果 共调查1702例PKP患者。PKP的原因依次是化脓性角膜炎542例（31．9％）、单纯疱疹病毒性角膜炎299例（17．6％）、圆锥角膜219例（12．9％）、角膜白斑164例（9．6％）、大泡性角膜病变118例（6．9％）、角膜破裂伤105例（6．2％）、再次PKP77例（4．5％）、角膜烧伤70例（4．1％）、遗传相关的角膜营养不良和角膜变性67例（3．9％）及其他41例（2．4％）。圆锥角膜（χ^2=26．399,P〈0．001）和大泡性角膜病变（χ^2=11．4229,P〈0．001）所占比例呈明显上升趋势,其他原因则无明显变化。化脓性角膜炎中真菌感染居首位（65．9％）,6年来各病原菌所占比例无明显变化。多数大泡性角膜病变患者有内眼手术史,其中白内障手术最常见（76．3％）。再次PKP的原发病以角膜烧伤（24．7％）、单纯疱疹病毒性角膜炎（23．4％）及化脓性角膜炎（14．3％）为主,再次手术的原因主要是免疫排斥（61．0％）、植片感染（14．3％）及单纯疱疹病毒性角膜炎复发（10．4％）。结论 感染性角膜病仍然是PKP的主要适应证,其中真菌感染为首位病因。圆锥角膜和大泡性角膜病变均呈明显上升趋势。（中华眼科杂志,2006,42：704-708）     

A description of human T-lymphotropic virus type I-related chronic interstitial keratitis in 20 patients

OBJECTIVE: This study aimed to describe a syndrome that the authors call human T-lymphotropic virus type I-related chronic interstitial keratitis. METHODS: A consecutive series of 194 human T-lymphotropic virus type I-infected patients (divided into 119 patients with human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis and 75 asymptomatic human T-lymphotropic virus type I carriers) was systematically examined. RESULTS: Twenty patients (10.3%) had bilateral anterior stromal lesions made up of approximately 10 elevated, rounded or cloudy whitish opacities that were more or less confluent. The opacities were characteristically situated at the periphery of the anterior stroma, and the visual axis remained unaffected. The interstitial keratitis was chronic and unresponsive to topical administration of corticosteroids. It was mainly observed in patients affected by human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis among whom there were 18 cases (15.1%), as opposed to two cases (2.7%) in asymptomatic carriers. CONCLUSION: A new cause of interstitial keratitis is reported. Human T-lymphotropic virus type I infection may have a much broader spectrum of ocular manifestations than previously described. As with the other manifestations of human T-lymphotropic virus type I infection, corneal lesions could be linked to a lymphoplasmocytic infiltration of the stroma leading to corneal opacities.     

Risk factors and causative organisms in microbial keratitis

PURPOSE: To establish the risk factors, causative organisms, levels of antibiotic resistance, patient demographics, clinical presentations, and clinical outcomes of microbial keratitis at a tertiary hospital in Australia. METHODS: Patients who had a corneal scraping for culture over a 5-year period were identified through the local microbiology database, and a retrospective audit of their medical records was carried out. Clinical information was gathered from medical records, and smear, culture, and antibiotic resistance results were from the microbiology database. An index of disease severity was calculated for each patient from scores for the magnitude of the epithelial defect and anterior-chamber reaction and the location of the lesion. Associations between risk factors for keratitis and variables such as patient demographics, causative organism and antibiotic resistance, disease severity, and outcome were analyzed by using analysis of variance and chi tests with appropriate correction for multiple comparisons. RESULTS: Two hundred fifty-three cases of microbial keratitis in 231 patients were included. Sixty percent of patients were men, and there was a bimodal distribution in the age of presentation. Common risk factors for keratitis were contact lens wear (53; 22%), ocular surface disease (45; 18%), ocular trauma (41; 16%), and prior ocular surgery (28; 11%). Gram stains were positive in 33%, with a sensitivity of 53% and specificity of 89%. Cultures of corneal scrapings were positive in 65% of cases, and Pseudomonas aeruginosa (44; 17%), coagulase-negative staphylococci (22; 9%), Staphylococcus aureus (19; 8%), and fungi (7; 3%) were commonly recovered. P. aeruginosa was more common than other culture results in contact lens-related cases (55% vs. 0%-23%; P < 0.001), and S. aureus was more common than other culture results in ocular surgery-related cases (29% vs. 0%-21%; P < 0.001). Patients with keratitis related to prior ocular surface disease had more severe keratitis at the time of scraping (P = 0.037). Cultures positive for Fusarium, P. aeruginosa, and other Gram-negative organisms had statistically significantly more severe keratitis at the time of scraping, whereas patients with negative cultures had milder keratitis (P = 0.030). Only 2% of all bacterial isolates were resistant to ciprofloxacin, 20% of Gram-positive isolates were resistant to cephalothin, and no Gram-negative isolates were resistant to gentamicin. CONCLUSIONS: In this series, the most common risk factor for keratitis was contact lens wear and the most commonly isolated organism was P. aeruginosa.     

Early corneal findings in Cogan's syndrome

We evaluated the ocular manifestations of Cogan's syndrome in 13 consecutive patients. The most frequent and earliest ocular finding was bilateral peripheral subepithelial keratitis consisting of faint, nummular lesions. The subepithelial keratitis was responsive to topical administration of corticosteroids. Peripheral subepithelial keratitis was seen in four patients and strongly suspected on review of history in three additional patients. Deep stromal keratitis was seen in two patients, while only one patient developed classic findings of Cogan's syndrome, ie. interstitial keratitis with vascularization. Additionally, five patients presented with noncorneal ocular inflammatory disease and deafness (atypical Cogan's syndrome). Early subepithelial keratitis in Cogan's syndrome may be mistakenly diagnosed as trival ocular inflammatory disease, and suppressed by topical corticosteroids, resulting in delayed diagnosis of Cogan's syndrome in the absence of classic corneal findings. Early diagnosis of Cogan's syndrome is important inasmuch as prompt treatment of cochlear symptoms with systemic corticosteroids may prevent or ameliorate deafness.     

角膜创伤致棘阿米巴感染的临床特征及治疗

目的 分析角膜创伤致棘阿米巴感染的角膜炎临床特征、治疗及琐后。方法 对20例（20眼）棘阿米巴性角膜炎的危险因素、临床表现、实验室榆查．治疗及其结果进行回顾性分析。结果 20例中，学生12例，农民6例。危险因素中包括戴角膜接触镜12例和角膜创伤6例。主要的临床表现为角膜溃疡、弥漫性基质浸润和环形溃疡。实验室检查：角膜刮片细胞学检查和棘阿米巴培养阳性率分别为95．00％（19／20）和60．00％（12／20），其中4眼在共焦显微镜检查下查见包囊。0．02％洗必泰，0．5％新霉素，0．4％甲硝唑滴眼液联合治疗，同时结合1％洗必泰局部烧灼和角膜清创。平均疗程为70天（18～150天）。19例溃疡愈合，形成角膜薄翳或白斑。其中7眼的最佳矫正视力≥0．5。结论 棘阿米巴性角膜炎的早期诊断至关重要，联合应用抗棘阿米巴药物、局部清创术和烧灼术为目前治疗的最佳选择．     

Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania

PURPOSE: To report the spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia. METHODS: We reviewed the records of 24 cases of culture-positive fungal keratitis treated from January 1991 to March 1999 at Wills Eye Hospital. Risk factors, fungal identification, antifungal treatment, and outcomes were evaluated. RESULTS: The study included 24 eyes (24 patients). Fourteen patients (58.3%) were female. The mean age was 59 years (range, 19-86 years). Predisposing factors included chronic ocular surface disease (41.7%), contact lens wear (29.2%), atopic disease (16.7%), topical steroid use (16.7%), and ocular trauma (8.3%). Early identification of fungal elements was achieved by staining of corneal scrapings in 18 cases (75%). Half of the cases (12 eyes) had corneal infections caused by yeast, and the other half by filamentous fungi. Candida albicans was the most commonly isolated organism (45.8%), followed by Fusarium sp (25%). Natamycin and amphotericin B were the topical antifungals most frequently used, while systemic treatment commonly used included fluconazole, ketoconazole, or itraconazole. Six patients (25%) had penetrating keratoplasty during the acute stage of infection. After a mean follow-up of nine months, 13 eyes (54.1%) had the best corrected visual acuity 20/100 or better. CONCLUSIONS: In contrast to other studies from the northern United States, we found Fusarium sp the most commonly isolated filamentous fungus. In our series, C. albicans was the most frequent cause of fungal keratitis, and a past history of ocular trauma was uncommon.     

Clinical forms of corneal abnormalities in atopic keratoconjunctivitis

Atopic keratoconjunctivitis (AKC) is presently considered as an individual nosological entity of ocular allergosis, which is associated with the systemic disease - atopic dermatitis. The clinical features of corneal lesions were studied in 40 patients with AKC. Those associated with the systemic pattern of an atopic process as a severe form of ocular allergosis were revealed. A classification of the clinical forms of corneal lesions in AKC as limbitis, epithelial microerosions, epithelial keratopathy, superficial keratitis in mild forms of the disease, is presented. The severe forms of AKC were characterized by corneal manifestations: extensive keratopathy, stromal keratitis with neovascularization without ulceration, corneal infiltrates and ulcers of bacterial and herpetic etiology.     

Corneal infection in mucosal scarring disorders and Sj?gren's syndrome

We reviewed 69 episodes of microbial keratitis occurring over an 11-year period in 56 patients with a mucosal scarring disorder or Sj?gren's syndrome. Gram-positive bacterial isolates were the most common cause of infection, and accounted for almost all cases in patients with Sj?gren's syndrome. Trichiasis (cicatricial pemphigoid), topical corticosteroids, bandage contact lenses, and corneal surgery were the main predisposing factors in the development of the corneal infection. In patients with ocular cicatricial pemphigoid, infection was much less common after chemotherapeutic control had been achieved. Recurrent infections were relatively frequent. There was a high rate of major complications, particularly in microbial keratitis complicating Sj?gren's syndrome.     

Medical treatment for combined Fusarium and Acanthamoeba keratitis

Purpose: Acanthamoeba and fungal keratitis are rare ocular infections. We report cases of combined Fusarium and Acanthamoeba keratitis and the clinical course of medical treatment. Methods: We reviewed the medical records of patients treated for culture‐proven Acanthamoeba keratitis at a referral centre, during 2001?2006. Results: Eleven consecutive patients were treated for culture‐proven Acanthamoeba keratitis during the 5 years, two of whom had combined fungal infections. A 29‐year‐old man presented with ground‐glass corneal oedema and epitheliopathy caused by contact lens use. The other patient, a 7‐year‐old girl, had eye trauma that led to a feathery corneal infiltrate. Both cases were treated with topical 0.02% polyhexamethylene biguanide (PHMB), 0.1% propamidine, 1% clotrimazole and 5% natamycin. Therapeutic keratoplasty was not required in either case. Conclusions: Timely identification of the pathogen, with repeated culture and smear if necessary, as well as adequate dosage to prevent recurrence is highly recommended in order to preclude the need for therapeutic penetrating keratoplasty.     

Serratia corneal ulcers: a retrospective clinical study

PURPOSE: To study the clinical and microbiological profile of Serratia corneal ulcers at the Cornea Service of the Wills Eye Hospital. METHODS: This was a retrospective, observational case series. The clinical records of patients with Serratia marcescens corneal ulcers seen at the Cornea Service of the Wills Eye Hospital between January 1, 1998 and December 31, 2002 were reviewed. RESULTS: Twenty-four cases of Serratia keratitis were identified in 21 patients. Two patients (9.5%) had recurrent keratitis, 1 of which recurred twice. Both had corneal graft edema and were on topical steroids and antiglaucoma drops. The Serratia infection in 15 patients (71%) was associated with an abnormal corneal surface. Twelve of these patients (57%) had the ulcer in a corneal graft, 4 (19%) of which were associated with suture infiltrates. Fifteen patients (71%) were on topical medications-15 used corticosteroids and 13 used antiglaucoma drops. Six patients (29%) were contact lens wearers-1 had a concomitant suture infiltrate associated with a corneal graft, and 5 had otherwise healthy corneas. One isolate lacked in vitro susceptibility to ciprofloxacin and ofloxacin but was susceptible to gentamicin and tobramycin. Nineteen patients had a favorable response to medical therapy. Two patients with poor outcome had large corneal ulcers with severe necrosis and thinning associated with delay in treatment. CONCLUSIONS: Serratia marcescens keratitis is associated with the presence of an abnormal corneal surface, use of topical medications, and contact lens wear. Prompt medical therapy results in a good clinical response in the majority of cases.