穿透性角膜移植治疗高危真菌性角膜溃疡51例(英文)

Penetrating keratoplasty for treatment of high-risk fungal keratitis A 51-case report

背景:单纯药物治疗高危真菌性角膜溃疡效果不佳,目前穿透性角膜移植已是挽救眼球和视力的主要手段。目的:观察穿透性角膜移植治疗高危真菌性角膜溃疡的随访结果。设计、时间及地点:回顾性病例分析,于2000-01/2007-01在青岛大学医学院附属医院眼科完成。对象:选择在青岛大学医学院附属医院行穿透性角膜移植的高危真菌性角膜溃疡患者51例(51眼),其中12例穿孔,前房积脓35例,移植前合并白内障8例,合并青光眼5例。方法:移植前给予抗真菌联合抗细菌治疗,51例患者均在入院4d内完成了穿透性角膜移植,移植后局部和全身给予抗炎和抗真菌药物治疗,随访6～24个月。主要观察指标:观察移植后视力变化和真菌复发、植片排斥、继发性青光眼、并发性白内障等并发症的发生情况。结果:①51例患者中18例随访6～12个月,25例随访13～18个月,8例随访19～24个月。②49例患者(占96.1%)成功地保存了眼球,48例(占94.1%)患者视力有不同程度提高。③移植后6例患者(占11.8%)真菌复发,其中4例药物治疗后治愈,2例摘除眼球;18例患者(占35.3%)植片发生排斥,其中13例经抗排斥治疗植片转为透明,5例因药物治疗无效而行二次穿透性角膜移植;4例患者(占7.84%)植片发生溃疡,其中3例治愈,1例因合并角膜内皮功能失代偿而行再次穿透性角膜移植;7例患者(占13.7%)继发青光眼,眼压均得到成功控制;6例患者(占11.8%)发生并发性白内障,其中3例行白内障摘除。其余患者移植后随访期间眼部情况稳定,植片保持透明。最终随访时,45例患者(占88.2%)角膜植片透明。结论:对于保守治疗无效的高危真菌性角膜溃疡患者,穿透性角膜移植是挽救眼球和视力的有效方法。

BACKGROUND： Simple drug therapy can not acquire satisfactory effects in treatment of fungal keratitis. At present, penetrating keratoplasy （PKP） has been considered a primary means to cure the fungal keratitis to save eyeball and vision. OBJECTIVE： To evaluate the clinical efficacy of PKP in the treatment of high-risk fungal keratitis. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at the Department of Ophthalmology, Affiliated Hospital of Qingdao University Medical University between January 2000 and January 2007. PARTICIPANTS： A total of 51 patients （51 eyes） with high-risk fungal keratitis who underwent PKP in the Affiliated Hospital of Qingdao University Medical College were recruited into this study. Of these patients, 12 suffered from perfored, 35 from hypopyon 8 from complicated cataract prior to surgery, and 5 from complicated glaucoma. METHODS： All patients received antifungal and antibacterial treatments prior to surgery and underwent PKP within 4 days following admission. After surgery, antifungal and antibacterial treatments were performed locally and systemically. All patients were followed-up for 6 24 months. MAIN OUTCOME MEASURES： Postoperative visual acuity, recurred fungal infection, rejection of implants, secondary glaucoma, and ulceration of implant. RESULTS： ① Of 51 patients, 18 were followed-up for 6 12 months, 2 for 13-18 months, and 8 for 19-24 months. ② A total of 49 （96.1%） out of 51 patients preserved the eyeballs and the visual acuity improved to different degrees in 48 （94.1%） patients. ③ After surgery, fungal infection recurred in 6 eyes （11.8%）, 4 of which were controlled by antifungal medication and 2 was enucleated because of uncontrolled endophthalmitis. Graft rejection was found in 18 （35.3%） eyes, 13 of which recovered transparent by medication and 5 received secondary PKP. Graft ulceration was present in 4 （7.84%） eyes, 3 of which were cured and the remaining one was re-grafted because of severe endothelial cell loss. Secondary glaucoma appeared in 7（13.7%） eyes, and the intraocular pressure was controlled medically and surgically. Complicated cataract occurred in 6 （11.8%） eyes, 3 of which underwent cataract extraction. Most complications were successfully controlled. In the final follow-up period, 45 （88.2%） grafts were transparent. CONCLUSION： PKP is an effective approach to preservation of eyeballs and restoration of visual function in patients with high-risk fungal keratitis, which can not be treated by conservative therapy.