无孢霉菌性角膜炎患者的临床特征及治疗转归

目的　探讨无孢霉菌性角膜炎患者的临床特征及治疗转归。方法　选择2009年3月至2019年3月在山东第一医科大学附属眼科医院诊断为无孢霉菌性角膜炎的患者64例（64眼），对患者的临床特征、实验室检查、治疗方法和转归进行分析。结果　64例（64眼）中，15例（23.4％）为中浅基质层溃疡和浸润，20例（31.3％）为深基质层溃疡和浸润，29例（45.3％）为深基质层溃疡和全层浸润。26例（40.6％）伴有前房积脓，5例（7.8％）伴有角膜穿孔，所有患者真菌培养均未见孢子生长。9例患者行药物治疗，11例患者接受角膜病灶切除术或结膜瓣遮盖术，17例患者行板层角膜移植术（LKP），24例患者行穿透性角膜移植术（PKP），3例患者行眼内容摘除术。总复发率为23.0％（14/61），其中药物治疗后复发率为22.2％（2/9），LKP后复发率为11.8％（2/17），PKP后复发率为41.7％（10/24），不同治疗方法之间复发率差异有统计学意义（χ²＝11.268,P<0.05；因行眼内容摘除术后无复发可能，统计中未计入眼内容摘除术患者），LKP组与PKP组患者复发率差异无统计学意义（P＞0.05）。术前合并穿孔的患者复发率为75.0％（3/4），高于无穿孔患者的复发率19.3％（11/57），差异有统计学意义（P<0.05）。前房积脓患者的复发率为30.4％（7/23），高于无前房积脓患者的复发率18.4％（7/38）（P＞0.05）。8例患者最终感染无法控制行眼内容摘除术，总治愈率为87.5％。复发患者总体治愈率为64.3%（9/14）。结论　无孢霉菌性角膜炎是一种严重的进行性感染性角膜疾病，角膜移植术后复发率高、预后差，应引起临床医师重视。

Clinical characteristics and treatment outcome of patients with nonsporulating molds keratitis

Objective　To evaluate the clinical characteristics, treatment outcome of patients with nonsporulating molds keratitis.Methods　Sixty-four patients (64 eyes) diagnosed with nonsporulating molds keratitis in the Shandong First Medical University Affiliated Eye Hospital from March 2009 to March 2019 were selected, and analyze the patient’s clinical characteristics, laboratory examinations, treatment methods, and treatment outcome.Results　Among the 64 patients(64 eyes)，fifteen patients(23.4%) had ulcers and infiltrations of superficial and middle stroma, 20 patients (31.3%) had ulcers and infiltrations of deep stroma,and 29 patients (45.3%) had deep stroma ulcers and full-thickness infiltration; 26 patients (40.6%) had hypopyon, and 5 patients (7.8%) were accompanied by corneal perforation. No spores grew during the fungal culture in all patients. Nine patients received medical treatment; 11 patients received corneal ulcer debridement or conjunctival flap covering cornea; 17 patients received lamellar keratoplasty (LKP); 24 patients received penetrating keratoplasty (PKP), 3 patients underwent extirpation of the eye content. The total recurrence rate was 22.9% (14/61), of which the recurrence rate after drug treatment was 22.2% (2/9), the recurrence rate after LKP was 11.8% (2/17), and the recurrence rate after PKP was 41.7% (10/24), and there was statistically significant difference in the recurrence rate of different treatment methods (χ²=11.268, P<0.05; Because there was no possibility of recurrence after eye evisceration, the eye evisceration patients was not included in the statistics). There was no difference in the recurrence rate of LKP group and PKP group (P>0.05). The recurrence rate of patients with preoperative perforation was 75% (3/4), which was higher than that of patients without perforation (19.3%, 11/57), and the difference was statistically significant (P<0.05). The recurrence rate of patients with hypopyon was 30.4% (7/23), which was higher than that of patients without hypopyon (18.4%, 7/38) (P>0.05). Eight patients with uncontrollable infection underwent extirpation of the eye content, and the total cure rate was 87.5%. The overall cure rate of recurrence patients was 64.3% (9/14).Conclusion　Nonsporulating molds keratitis is a serious progressive infectious corneal disease. The recurrence rate after corneal transplantation is high and the prognosis is poor, so it should be taken seriously by clinicians.