马来西亚大学医学中心角膜溃疡的回顾分析

Review of corneal ulcers at University Malaya Medical Centre

目的：分析角膜溃疡的病例分布、危险因素、临床特点、微生物检查及预后结果。方法：对2003-07／2006-04就诊于马来西亚大学医学中心的84例（87眼）患者进行研究，其中1例双眼发病，另1例曾因疱疹性角膜炎复发3次就诊。选入标准包括角膜上皮缺损、角膜基质浸润及炎症。结果：患者84例中有男46例，女38例。主要是马来人（52％）。3个主要的危险因素是角膜接触镜的配戴（47％），眼外伤（25％）及眼表疾病（24％）。在老年患者中，糖尿病（8％）及高血压（9％）是重要的系统性疾病。阳性为25％，而微生物培养阳性为73％。在各危险因素组中，绿脓杆菌是最常见的致病菌，在角膜接触镜配戴者中最高。耐庆大霉素革兰染色阴性菌有2例，耐青霉素表皮葡萄球菌有1例。75％的患者溃疡愈合，遗留角膜混浊。2mo后，54％的患眼最佳矫正视力〉6／18，14％〈3／60。3例患者需要行眼球摘除或剜除术。结论：角膜接触镜配戴和眼外伤是青年人群中主要的可预防性危险因素，相反，眼疾是老年人中不可预防的危险因素。超过60％的培养阳性病例为革兰染色阴性菌。

AIM： To describe the demography, risk factors, clinical features, microbiological findings and outcome of cases diagnosed as corneal ulcers. METHODS： Eighty-four patients （87 eyes） admitted to University Malaya Medical Centre （UMMC） between July 2003 and April 2006 were studied. One patient had bilateral corneal ulcers and another had three separate admissions for recurrence of herpetic keratitis. Inclusion criteria included cases of epithelial defect with stromal infiltrate and inflammation. RESULTS： There were 46 female and 38 male patients. The majority were Malays （52%）. The three major ocular risk factors were contact lens wear （47%）, eye trauma （25%） and ocular surface disease （24%）. Diabetes mellitus （8%） and hypertension （9%） were important systemic diseases seen in the older patients. Gram stain was positive in 25% while positive cultures were obtained in 73%. Pseudomonas aeruginosa was the commonest pathogen in every risk factor group, being highest in contact lens users. Two cases were of gentamicinresistant gram negative bacteria and one was of methicillin-resistant Staphylococcus epidermidis. 75% of cases healed leaving corneal opacities. After two months, 54% of eyes had best corrected visual acuity （BCVA） better than 6/18 while 14% had worse than 3/60. Three cases required evisceration or enucleation. CONCLUSION： Contact lens wear and ocular trauma were the major preventable risk factors in the younger population, in contrast to ocular disease which was an unpreventable risk factor in the elderly. Gram negative organisms were responsible for more than 60% of culture positive cases.