角膜塑形术致感染性角膜溃疡的临床分析

目的分析总结16例角膜塑形术(orthokeratology,OK)镜治疗过程中发生的绿脓杆菌、真菌和棘阿米巴性角膜溃疡的临床过程、治疗经过及转归.方法根据感染病原微生物的不同,用微生物学方法对16例行OK镜治疗致角膜溃疡患者进行检测,采取不同的敏感药物治疗,对9例角膜感染严重、药物治疗不能控制或濒于穿孔的患者,行板层或穿透性角膜移植术.总结并分析其临床转归及治疗效果.结果 16例中,角膜刮片细长杆菌7例,棘阿米巴7例,真菌1例,未检出1例.角膜溃疡刮片培养铜绿假单胞菌7例,棘阿米巴7例,真菌1例,未检出致病菌者1例.治疗药物治疗7例,板层角膜移植术6例,穿透性角膜移植术3例.治疗后视力＞0.1者7例,0.02～0.1者4例, ＜0.02者5例.结论感染性角膜溃疡是OK治疗近视最严重的并发症,应积极抗感染治疗,必要时应及时行角膜移植术.虽然最终感染可得以控制,但明显损害患者视力.

Orthokeratology induced infective corneal ulcer

Objective To investigate the clinical course, treatment and outcome of infective corneal ulcer induced by orthokeratology. Methods Sixteen cases of infective corneal ulcer caused by orthokeratology were reported, including 7 cases of pseudomonas corneal ulcers, 8 cases of acanthamoeba keratitis and 1 case of mycotic keratitis. Smears and cultures from corneal scrapings for bacteria, fungi and amoeba were performed for all of the patients. According to the results of pathogenic microorganisms, different therapeutic approaches were given. Lamellar keratoplasty or penetrating keratoplasty was performed for 9 patients whose corneal lesions were serious and unresponsive to medical therapy. Results After medical treatment or keratoplasty, corneal infections of all the patients were controlled. The visual acuity of most cases was improved. Conclusions The infective corneal ulcer is the most serious complication of orthokeratology. The treatment of infective corneal ulcer should be directed toward the elimination of the pathogenic microorganisms from the cornea. Keratoplasty continues to have a central role in the management of some advanced cases. Although the infections can be controlled, the vision of these patients is seriously damaged.