激光原位角膜磨镶术后非结核分枝杆菌性角膜炎的研究现状

随着LASIK手术的普遍开展，术后并发感染性角膜炎的病例报道不断增多。非结核分枝杆菌(NTM)是导致术后感染性角膜炎的主要病原微生物之一，其中以龟分枝杆菌及偶发分枝杆菌最常见。LASIK术后NTM角膜炎的起病缓慢，早期无特异性症状，随病情的发展出现眼痛及视力下降。典型的临床体征为角膜基质多灶性点片状浸润，严重者可出现瓣下脓肿、角膜瓣坏死。对于LASIK术后2—3周角膜出现浸润病变或角膜瓣下出现结晶样角膜病变，应高度怀疑NTM角膜炎，其病因学诊断须依靠实验室检查。LASIK术后NTM角膜炎的治疗方法包括药物治疗、角膜瓣下的冲洗及手术治疗。治疗的原则为：药物治疗与手术治疗相结合，局部治疗与全身治疗相结合。目前最常用的抗生素为阿米卡星、克拉霉素及氟喹诺酮类抗生素。

Advance in non-tuberculous mycobacterial keratitis after laser in situ keratomileusis

With the extensive use of laser in situ keratomileusis(LASIK), an increasing incidence in the postoperative infected keratitis has been reported. Non-tuberculous mycobacterium(NTM)is one of the major pathogens, which results in infectious keratitis after LASIK. M.chelonae and M.fortuitum are the most common species. Clinically, postoperative NTM keratitis has a relatively indolent course, which has no specific symptom in the early episode. With the development of the infection in the cornea, eye pain and decrease of visual acuity will appear. The typical clinical manifestation is the multifocal stromal infiltration in or under the flap. In some severe cases, the necrosis and abscess formation of the flap of the cornea could be observed. NTM keratitis should be highly suspected in patients with LASIK when cornea infiltration and infectious crystalline keratopathy are found in 2-3 weeks postoperatively. The etiological diagnosis of the NTM keratitis depends on the laboratory investigations. The management of NTM keratitis mainly includes medication, subflap irrigating and surgical treatment. The therapeutic principles are combination of medication (local plus systemic administration) with surgery. The antibiotics reported to be effective against NTM keratitis include amikaci,clarithromycin and fluoroquinolone.