感染性角膜炎183例回顾性分析

Clinical analysis of 183 cases with infectious keratitis.

目的分析183例（187眼）感染性角膜炎的病因、治疗方法和结果。方法明确角膜感染的种类，采用药物和手术进行治疗，治疗后观察临床效果。结果单眼发病179例，双眼发病4例。发病年龄为1～80岁，平均（52．75±15．08）岁。男117例，女66例。真菌性角膜溃疡84眼（44．92％），细菌性角膜溃疡28眼（14．97％），病毒性角膜炎14眼（7．49％），细菌真菌混合感染5眼（2．67％），病因不确定56眼（29．95％）。单纯药物治疗者118眼（63．10％），清创联合结膜瓣遮盖术24眼（12．83％），清创联合羊膜移植结膜瓣遮盖术19眼（10．16％），治疗性角膜移植术18眼（9．63％）（其中穿透性角膜移植术16眼，板层角膜移植术2眼），泪囊鼻腔吻合术5眼（2．67％），眼内容摘除术5眼（2．67％），其中2眼为羊膜移植失败者。结论真菌性角膜炎是感染性角膜炎的主要病因，局部清创联合安尔碘Ⅲ稀释液冲洗及药物治疗对大部分感染性角膜炎有效，部分患者仍需要手术治疗。

Objective To analyse the pathogenesis, treatment and result of 183 in-patient with infectious keratitis form January 2004 to December 2009. Methods Clinical manifestations, pathogenesis re- sults was used to clear different corneal infections. Operations and drugs were used to treat these diseases. and results were observed during whole in-patient period. Results All infectious eyes were seen in 179 cases with one eye affected and 4 cases with both eyes affected,the age between 1 - 80 years,mean age 52. 75 years;male 117 cases（ 119 eyes） and female 66 cases（68 eyes）.84 eyes with fungal infection,28 eyes with bacterial infection, 14 eyes with viral infection,5 eyes with mixed infection and 56 eyes with unknown infection;ll8 eyes received drug treatment （63.10%）,24 eyes received local debridement combined with conjunctival flap microsurgery （ 12.83% ）, 17 eyes received local debridement combined with amniotic membrane transplantation and conjunctival flap microsurgery （9.09%）, 18 eyes received keratoplasty （9.63%） （ 16 eyes with penetrating keratoplasty. 2 eyes with lamellar keratoplasty）, 5 eyes received dacryocystorhinostomy （2.67%） and 5 eyes with enucleation （2.67%）. Conclusion Fungal keratitis is the main cause for infectious keratitis;early diagnosis and early drug therapy are effective in most patients, however, some patients need surgery.