角膜塑型术相关性角膜感染的病因学分析

Infectious complications of the cornea related to Orthokeratology

目的 :分析角膜塑型术 (Orthokeratology ,简称OK镜 )相关性感染性角膜并发症的病原体种类。方法 :总结分析从 2 0 0 0年 3月至 2 0 0 1年 8月间发现的 2 8例与配戴角膜塑型镜有关的角膜感染病例及其致病病原体的种类。结果 :2 8例角膜微生物检查结果 :细菌培养阳性 11例 ,(其中铜绿假单胞菌属 8例、星形奴卡氏菌 1例和革兰阴性杆菌 2例 ) ;真菌 2例 ;棘阿米巴属 11例 ;培养阴性 4例 ,培养阳性率为87.5 % (2 4 / 2 8)。结论 :配戴角膜塑型镜可导致角膜多种微生物的严重感染 。

Objective:Orthokeratology is one of the nonsurgical procedures to reduce myopia with the rigid contact lenses to flatten the cornea sufficiently. Although advocates maintain that orthokeratology is safe and effective,there is still a possibility of corneal ulceration related to microbial infections. In this article,we report the cases of infectious keratitis related to Orthokeratology treatment by overnight wearing.Methods:To review the 28 cases of infectious keratitis related to Orthokeratology and analyze the types of the pathogens which resulted in the infections of the cornea.Results:From March of 2000 to August of 2001,28 cases of infectious keratitis related to Orthokeratology by overnight wearing were diagnosed in Beijing Institute of Ophthalmology. All cases were students in schools or colleges,including 10 male and 18 female. Average age was 16 year old(10～21 years). The durations of Orthokeratology treatment by overnight wearing were from 16 days to one and half year. Corneal scrapings were taken from all of 28 cases and processed for microbial culture and evaluation. Corneal cultures isolates from 28 cases showed that the number of bacterial positive cultures were 11(including Psuedomonas 8),fungal positive cultures were 2,acanthomoeba positive cultures,11 and negative cultures,4. The rate of positive culture was 87.5%(24/28)Conclusion:Infectious corneal ulcer is by far the most serious complication associated with Orthokeratology treatment by overnight wearing. There are probably several factors contributing to the development of infectious corneal ulceration. These include corneal hypoxia,poor clearing procedures,tight bending of the cornea and poor follow up program. Orthokeratology in overnight wear could result in the severe infectious complications of the cornea and ophthalmologists ought to pay an intensive attention to these complications.