治疗性角膜移植术后缝线侵蚀及周围脓疡微生物和临床特点

Microbial investigation and clinical features on suture erosions and abscesses after therapeutic corneal transplantation

目的 分析治疗性角膜移植术后缝线侵蚀及周围脓疡的微生物学和临床特点.方法 应用总结2年内连续发生的治疗性角膜移植术后缝线侵蚀和周围脓疡共11例,真菌角膜溃疡9例和复发性角膜基质炎合并穿孔2例.对病灶及结膜囊进行细菌和真菌培养,记录病灶的特点和治疗方法 与结果.结果 11例缝线侵蚀和周围脓疡均发生于术后3个月以内,平均31.8天.其中3例细菌培养阳性,2例结膜囊和缝线病灶培养菌种一致.病灶多发生在上方和睑裂区,其中上方为4例,占36.3%;发生在睑裂区3例,占27.3%.2例司时发生排斥反应.治疗方法 为及时拆除缝线,局部应用敏感抗生素,均l周内治愈.结论 治疗性角膜移植术后缝线侵蚀及周围脓疡发生较早,与眼睑摩擦、缝线松脱、术区污染、植床的炎症等有关.大部分为非感染性,少部分感染者多为革兰氏阳性菌.主要治疗措施是拆出侵蚀和松脱缝线,局部应用敏感抗生素.及时发现、及时治疗预后良好.

Objective To investigate the microbial profiles and clinical features on suture erosions and abscesses after therapeutic corneal transplantation. Methods Of 11 consecutive cases of suture erosions and abscesses after therapeutic corneal transplantation were enrolled within 2 years, including 9 cases fugal keratitis and 2 cases recurrent stromal keratitis with perforation. In each case, both bacterial and fungal cultures were taken from eroded sutures and conjunctival sac. Clinical features on suture erosions and abscesses were recorded, including therapeutic regimen and results. Results All episodes of suture erosions and abscesses occurred within 3 months postoperatively, on average 31.8 days. Of the 11 cases, 3 had positive cultures and,suture and cul-de-sac cultured micro-organisms matched in 2 cases. Suture erosion and abscess were primarily located superior and palpebral fissure area, with 4 （36.3%） superiorly and 3 （27.3%） palpebrally. Graft rejection in 2 cases was determined clinically. Removal of involved sutures and sensitive topical antibiotic were employed and all cases healed within 1 week. Conclusions Suture erosions and abscesses after therapeutic corneal transplantation occur on early stage, associating with eyelid rubbing, loosening of sutures, contamination and inflammation of bed. Most cases are sterile, gram-positive bacteria are most common cultured organisms in infected ones. Therapeutic strategies are removal of involved sutures and sensitive topical antibiotic. Diagnosis and treatment in a timely fashion contribute to good prognosis.