滴眼剂药物毒性角膜损害分析

Analysis of Drug Toxic Keratopathy Induced by Eyedrop

目的分析滴眼剂导致的药物毒性角膜损害的发病机理、临床特征及治疗方法。方法回顾性分析29例（35眼）药物毒性角膜病变。统计发病时眼药使用品种、频率、周期以及防腐剂种类;总结角膜形态特点、药物毒性角膜病变的病因、治疗方法与疗效。结果药物毒性角膜病变具有特定的形态特点。均有多种局部眼药混合、频繁、长期使用史。平均使用滴眼剂（5±0.3）支;平均日使用（16±2）次;平均使用（27±7.2）d。均有多种角膜药毒性药物的频繁、叠加使用情况。眼药水防腐剂种类分别为：苯扎氯铵（33.33%）;尼泊金乙酯（羟苯乙酯）（25.0%）;苯扎溴铵（16.67%）;山梨酸（16.67%）;硫柳汞（8.33%）。停用原用滴眼剂、使用低角膜毒性药物治疗,时间7~21 d,平均（14±4）d。治愈30眼（85.71%）,好转5眼（14.29%）。结论滴眼剂药物毒性角膜损害与不合理用药有关;具有一定的临床特征;停用原用滴眼剂、使用低角膜毒性药物治疗效果明确。眼科临床医师认识滴眼剂药物毒性、准确诊断、规范用药是避免药物毒性角膜损害的关键。

OBJECTIVE To analyze the pathogenesis, clinical feature and treatment of drug toxic keratopathy due to eyedrops. METHODS Twenty-nine cases（35 eyes） with drug toxic keratopathy were studied retrospectively. The kinds of eyedrops and preservative, the frequency and period of eyedrops used were statistically analyzed. The clinical feature, pathogenesis, treatment and effect of drug toxic keratopathy were summarized. RESULTS Drug toxic keratopathy had specific morphological charact- eristics. All patients presented with a frequent and long term using of multiple eyedrops history. The average eyedrops used was 54-0.3, daily using was （16±2） times and the days of using was （27±7.2）d. The preservative types of eye drops were statistically analyzed： benzalkonium chloride（33.33%）, ethylparaben（25.0%）, benzalkonium bromide（16.67%）, sorbic acid（16.67%） and thiomersal（8.33%）. The treating time was 7-21 d, average （144±4）d. After treatment, the clinical symptoms recovered in 30 eyes （85.71%）, improved in 5 eyes（14.29%）. CONCLUSION Drug toxic keratopathy has a certain clinical characteristics, due to irrational eyedrops using. Timely discontinuing of the formerly used eyedrops and using low toxicity eyedrops, having a full realization of the toxic effects of eyedrops to cornea, accurate diagnosis and rational use of drug are the keys to avoid drug toxic keratopathy.