单疱病毒性角膜炎的分型与治疗

Classification and Treatment of Herpes Simplex Keratitis

【目的】评价Holland等提出的单疱病毒性角膜炎（HSK）新分类法在诊治HSK时的指导意义及皮质类固醇类药物在治疗HSK时的作用。【方法】对本院临床诊治的73例（92眼）HSK患者应用Holland等提出的新分类法进行分类，再根据不同类型的HsK在抗病毒治疗的基础上灵活应用皮质类固醇类药物进行治疗，观察其临床疗效。【结果】本组73例（92眼）HSK患者中，感染性角膜上皮炎型42眼，均治愈；基质型角膜炎34眼中，26眼免疫性基质型角膜炎均治愈，8眼坏死性角膜基质炎中3眼药物治疗无效而行穿透性角膜移植2眼，行深板层角膜移植术1眼，其余5例坏死性角膜基质炎患者治愈；内皮型角膜炎16眼，均治愈。【结论】Holland等提出的HSK新分类法在临床诊治HSK时具有很好的指导作用，灵活巧妙应用皮质类固醇类药物在治疗HSK时能收到满意的治疗效果。

[Objective] To evaluate the significance of a new classification of herpes simplex keratitis （HSK） proposed by Holland et al in the diagnosis and treatment of HSK and the effect of steroids in the treatment of HSK. [Methods] A total of 73 HSK patients（92 eyes） confirmed by clinical diagnosis in our hospital were classified by a new classification system proposed by Holland et al. According to different types of HSK, patients were treated with steroids on the basis of antivirus treatment. The clinical effect was observed. [Results]Of the 73 HSK patients（92 eyes）, 42 eyes with infectious corneal epithelitis and 26 eyes with immune stromal keratitis in 34 eyes with stromal keratitis were all cured. Among 8 eyes with necrotizing stromal keratitis, 3 eyes failed to the drug therapy in which 2 eyes underwent penetrating keratoplasty and one eye underwent full-thickness lamellar keratoplasty, and the other 5 eyes were cured. Sixteen cases with endothelial keratitis were all cured. [Conclusion] The new classification system proposed by Holland et al has a good significance for guiding the diagnosis and treatment of HSK. Using steroids skillfully and nimbly for the treatment of HSK can have a satisfactory effect.