荧光素染色下角膜激光光凝对真菌性角膜溃疡菌丝结构影响

The effect of laser photocoagulation on the hyphal structure of fungal corneal ulcer detected by using fluorescein staining

目的观察荧光素染色下角膜激光光凝治疗对真菌性角膜溃疡菌丝结构的影响。方法前瞻性随访观察深圳市眼科医院于2016年1月至2016年8月经共焦激光角膜显微镜确诊的真菌性角膜溃疡28例（28只眼），其中男19例，女9例；年龄24~63岁，平均（44.00±0.00）岁，发病时间3~18 d，平均（9±0.00）d，其中伴有前房积脓患者9例；所有患者在给予局部抗真菌药物氟康唑滴眼液、那他霉素滴眼液治疗的同时给予溃疡灶荧光素染色导入色素颗粒，表面麻醉下行角膜激光光凝治疗，并利用共焦激光角膜显微镜检查定位真菌菌丝位置、范围以及激光术后菌丝结构的改变情况。结果经过共焦激光角膜显微镜检查定位菌丝位置，角膜荧光素染色下激光光凝治疗，28例角膜溃疡患者病情完全得到控制，前房积脓逐渐吸收；激光光凝治疗后经共焦激光角膜显微镜检查见溃疡灶内真菌菌丝结构断裂、熔解、逐渐消失，术后随访观察3~6个月未见溃疡复发。结论荧光素染色下角膜激光光凝治疗可以使真菌性角膜溃疡灶内真菌菌丝结构碎裂、熔解、消失；在共焦激光角膜显微镜协助检查下能够明确定位菌丝的位置及范围；因此，该方法对真菌性角膜溃疡的治疗是一种安全、准确、有效地治疗新思路。

ObjectiveTo observe the effect of laser photocoagulation on the hyphal structure of fungal corneal ulcer by using fluorescein staining.MethodsA prospective research of 28 patients （28 eyes） diagnosed as Fungal Keratitis by using confocal laser corneal microscopy were followed up, who recruited from January 2016 to August 2016 in our hospital. Among them 19 males （19 eyes） and 9 females （9 eyes） with age ranging from 24 to 63, averages （44.00±0.00） years old. The average onset time was from 3 to 18 days, averaged （9.00±0.00） days. And hypopyon were observed in 9 cases （9 eyes）. Besides topical anti-fungal Fluconazole Eye Drops and Natamycin Eye Drops, all patients also received fluorescein staining and laser photocoagulation under topical anesthesia for their cornea. Meanwhile, in vivo confocal laser-scanning microscopy were used to detect the positioning location, scope and structure changes after laser surgery of the fungal hyphae.ResultsLaser photocoagulation on the hyphal structure of fungal corneal ulcer detected by using fluorescein staining. Laser photocoagulation on the hyphal structure of fungal corneal ulcer detected by using fluorescein staining. Fungal corneal ulcer in the 28 patients （28 eyes） were all under control after the laser photocoagulation detected by using fluorescein staining. And hypopyon were decreased gradually in the 9 patients. After laser photocoagulation, the fungal mycelium structure in the ulcer was broken and melted detected by Confocal laser corneal microscopy. Noulcer recurrence was observed in 3 to 6 months after the follow-up.ConclusionsLaser photocoagulation detected by using fluorescein staining leads to structural breakdown of the fungal hyphae of Fungal Keratitis. Confocal laser corneal microscopy is helpful to detect the positioning location, scope and structure changes after laser surgery of the fungal hyphae. Therefore, it is a safe, effective and precise way for the treatment of Fungal Keratitis.