感染性角膜炎196例临床分析

Clinical analysis of 196 infectious keratitis in Jingzhou Region

目的分析196例感染性角膜炎住院患者的发病特点及疾病转归，为地区性角膜病的防盲治盲工作提供参考依据。方法对2010年1月至2012年12月在荆州市中心医院眼科符合人选标准的196例感染性角膜炎患者的临床资料、发病特点、致病因素、实验室检查结果、治疗效果等进行回顾性分析。结果196例（198只眼）感染性角膜炎中，男性118例120只眼，女性78例78只眼。发病平均年龄58．6岁，主要集中于41～60岁。主要致病因素为角膜外伤、继发眼表感染、角膜接触镜的配戴、皮质类固醇的使用以及继发手术感染。根据临床表现及实验室检查结果，诊断为真菌性角膜炎128例128只眼（65-3％），居感染的首位，病毒性角膜炎47例49只眼（24．0％），细菌性角膜炎患者21例21只眼（10．7％）。在真菌性角膜炎中，角膜刮片直接镜检法的诊断阳性率为67．2％。123例培养结果中，46例呈阳性，其中细菌8例，真菌38例。患者从发病至来院就诊时间为1-90d，平均（32±7．4）d。60例患者接受手术治疗，其中24例行病灶清创联合球结膜遮盖术，12例行病灶清创联合羊膜移植及结膜瓣遮盖，8例转上级医院行角膜移植术，最终行眼内容物剜除16例，包括3例羊膜移植手术失败者。结论真菌性角膜炎是感染性角膜炎住院患者的主要病因，其次为病毒性。近年来，真菌性角膜炎发病率呈明显上升趋势，药物治疗无效时，行病灶清创联合羊膜移植和（或）球结膜遮盖可以有效降低患者视力丧失，挽救眼球，值得推广。

Objective To investigate the general features, epidemiology and sequelae of 196 in-fectious keratitis in Jingzhou Region, and to provide proper evidences for blindness prevention. Methods Retrospective review of the general features, predisposing factors, laboratory examination and treatment effectiveness were collected and analyzed in 196 patients with confirmed infectious ker- atitis in our hospital from January 2010 to December 2012. Results Among the 196 patients （198 eyes）, 118 （120 eyes） were male and 78 （78 eyes） were female with mean age at 58.6 years. The age distribution was mainly 41-60 years old. The important risk factors were corneal trauma, ocular surface disease, contact lens wear, steroid use and previous ocular surgery. The leading infectious ker-atitis was fungal keratitis （128 patients, 128 eyes, 63.5%） and followed by viral keratitis （47 pa-tients, 49 eyes, 30.0%）. Twenty-one patients （21 eyes, 10.7%） were confirmed with bacterial kerati-tis. The positive rate of direct microscopic examination of corneal scraping was 67.2% in fungal ker-atitis. In 123 cultured specimens, 46 cases （37.4%） were detected positive, 8 showed bacterial growth, and 38 demonstrated fungal growth. The median time from inciting event to receiving treat-ment in our hospital was 32±7.4d. Sixty eyes received operation. Among them, 26 eyes undertook lo-cal debridement with conjunctival flap covering, 12 eyes received local debridement with amniotic membrane transplantation and conjunctival flap covering, 8 patients went to higher hospital for kerato-plasty, and 17 eyes received enucleation finally. Conclusions Fungal keratitis is the major cause of corneal infections and is followed by viral keratitis in Jingzhou Central Hospital. An incremental in-crease is seen in the number of fungal keratitis cases and bacterial keratitis show a decline during the study period. This disconcerting trend and the fairly high rate of blindness resulting in infectious keratitis warrant further research. Patients with infectious keratitis have generally poor visual out- comes and accepted treatment promptly may improve the outcome. Local debridement with conjuncti-val flap covering and/or amniotic membrane transplantation is a method reserved to be recommended when drug treatment is unhelpful.