准分子激光角膜屈光手术后疱疹病毒性角膜炎的研究进展

Current research in herpetic keratitis following excimer laser corneal refractive keratectomy

准分子激光角膜屈光手术后并发单纯疱疹病毒（HSV）感染常可引起视力的严重损害。导致准分子激光角膜屈光手术后并发疱疹病毒感染的主要原因有：准分子激光照射和手术刺激诱发潜伏的HSV活化；术后局部长期应用糖皮质激素类滴眼液，也可是上述因素综合作用的结果。及时诊断及有效的抗病毒治疗是恢复视力的关键，血清抗体检测、病毒培养、角膜上皮刮片、组织细胞切片和Negative染色、聚合酶链反应（PCR）等实验室检测均存在一定的限制，而多重PCR可能会成为有效的实验室诊断方法。准分子激光角膜屈光手术后并发HSV感染的治疗方法主要是根据病情局部或全身应用抗病毒药物，对于术前曾有单纯疱疹病毒性角膜炎（HSK）病史的患者围手术期局部给予抗病毒药物可显著降低准分子激光角膜屈光手术后疱疹病毒感染的发生率。根据近年来国内外相关的临床研究及基础研究，对准分子激光角膜屈光手术后合并HSK的病因、诊断、治疗及预防进行综述。

Herpes simplex virus infection after excimer laser corneal refractive surgery often leads to serious complications, and the main reasons to induce the infection of herpes simplex virus are ： irradiation of excimer laser and stimulation of corneal by surgery;long-term topical administration of steroids eye drops,or the interaction of all above factors. Once the herpetic keratitis appears,early and correct diagnosis and management are critical for rescuing the visual acuity. The laboratory assay methods, such as serum antibody, virus culture, corneal epithelial scraping, pathological examination,polymerase chain reaction （PCR）, can be used for the assistance of diagnosis but each methods has their own limitation;it is recognized that the multiplex PCR seem to become more sensitive. The primary treatment method for the infection of herpes simplex virus is to use the anti-virus drug topical or systemically after excimer laser corneal refractive keratectomy, the topical use of antivirus drugs in perioperation period for patients with history of herpetic keratitis can reduce the recurrence. This paper summarized the progress in clinical and experimental researches and review the etiology, diagnosis, treatment and prevention of herpetic keratitis following excimer laser corneal refractive surgery in recent years.