共聚焦显微镜在真菌性角膜炎诊治中应用观察

The observation of clinical application of confocal microscopy in the diagnosis and treatment of fungal keratitis

目的观察共聚焦显微镜在真菌性角膜炎的诊断及治疗中的作用。方法（1）收集2011年9月至2012年9月在西安市第一医院眼科就诊的真菌性角膜炎患者54例，入院时即行共聚焦显微镜及角膜刮片检查。（2）在对共聚焦显微镜确诊病例的治疗过程中，分别在第1、2、3、4周再对这些病例进行共聚焦显微镜检查，监测角膜病灶变化。结果54例患者中共聚焦显微镜检出52例，诊断率为96．3％，角膜刮片检出49例，诊断率为90．7％，二者差异无统计学意义（P〉0．05）。54例患者中22例伴有前房积脓；49例有植物性外伤或异物进入史，约为90．74％；有1例患者因感染未控制致角膜全溶解、眼内炎行根治性手术治疗。共聚焦显微镜下可见真菌性角膜炎的抗感染治疗一般2周时起效，2-3周时病情好转，第4周时感染基本得到控制。此时可根据角膜病灶情况选择结膜瓣遮盖或羊膜移植手术，以促进角膜修复。结论共聚焦显微镜检查安全无创伤，可重复性强，对真菌性角膜炎的诊断快速，可监测角膜病情变化，指导临床治疗，提高治愈率。

Objective To observe the effect of confocal microscopy in the diagnosis and treat- ments of fungal keratitis. Methods Fifty-four patients of fungal keratitis were selected from our hos- pital from 2011.9 to 2012.9, checked by confocal microscopy and cornea scraping, The changes of corneal lesion by confocal microscopy were examined, respectively in the lth, 2th, 3th, 4th week. Results Fifty-two patients were diagnosed by confocal microscopy, diagnosis rate was 96.3%, 49 pa- tients were diagnosed by cornea scraping, diagnosis rate was 90.7%. The two diagnosis rate had no statistics difference （P 〉0.05）. Among the patients, 22 had hypopyum, 49 had the history of trauma or foreign body, about 90.74%, the infection of 1 patient was not controlled and then cured by radi- cal operation. By eonfocal microscopy, the anti-infective therapy effected at 2th week after anti-fun- gus therapy, pathogenetic condition improved at 2-3th week, and the infection was controlled at the 4th week, and then conjunctival flap covering or amniotic membrane grafting could be chosen to pro- mote cornea recovery at this time. Conclusions Confocal microscopy examination is non-invasive and secure, with strong repeatability and short time, can be used to monitor the states and changes of corneal, can be used to conduct clinical therapy and improve the cure rate.