穿透性角膜移植术治疗真菌性角膜炎术后复发的治疗分析

Treatment of recurrent fungal keratitis after penetrating keratoplasty

目的探讨真菌性角膜炎行穿透性角膜移植术(PKP)后复发的治疗。方法2000年1月至2008年6月于我院因真菌性角膜溃疡行PKP共497例(498只眼),其中术后复发共有32例(32只眼)患者。对其临床特征、病原学、复发率、复发时间、复发表现及处理进行回顾性分析,分析复发的危险因素、菌种、复发表现及其处理之间的关系。结果真菌性角膜溃疡行PKP的复发率6.43%,早期复发于术后3 d左右,晚期复发20～60 d之间。复发的位置与术中未彻底切除的病灶有关。共27只眼复发后继续接受治疗,复发治愈率81.48%。其中单纯应用抗真菌药物治愈占33.3%,病灶切除18.5%,再次PKP占25.9%,眼内容剜除18.5%。结论根据复发部位的不同选择合适的治疗方式可挽救多数眼球。

Objective To evaluate the treatment of fungal recurrence after penetrating keratoptasty. Methods We have reviewed 32 patients （ 32 eyes） of fungal recurrence about their clinical features, pathogen, and the recurrent rate , time ,features and treatment among 497 patients （ 498 eyes） of fungal keratitis （FK） from the January 2000 to July 200g, and summarized the risk faetor,fungal strain, and the relationship between the recurrent features and treatment. Results There was 6.43% of recurrent rate. earlier recur 3 day and later recur 20 - 60 day postoperation. The site of recurrence related with not thoroughly cleaning the infection. There was 27 patients accept treatment, 81.48% of curing rate,33.3% cured with antifungal drug, 18.5% with ablation corneal reecurent site,25.9% with PKP and 18.5% with enucleation. Conclusion The appropriate selection of treatment according to the site of receurenee can saved most of eyes.