带状疱疹角膜炎的综合治疗及视力预后相关因素分析

Treatment and factors affecting vision prognosis in herpes zoster keratitis

目的分析带状疱疹角膜炎的临床特征和治疗以及影响视力预后的相关因素。方法 2010年1月—2015年6月于我院住院治疗确诊为带状疱疹角膜炎患者70例。对具有完整病历资料的58例患者进行回顾性分析,分析其就诊时间、相关病史、诊前的治疗情况。对所有患者应用更昔洛韦注射液5 mg/kg,每日2次,并联合局部更昔洛韦凝胶每日4次;根据病情局部或全身联合应用糖皮质激素治疗,所有病例预防性应用抗生素滴眼液,并给予人工泪液及角膜保护剂治疗。观察患者就诊时,治疗后1周、治疗后1月的平均最佳矫正视力(BCVA best corrected visual acuity)、眼压、角膜及眼内炎症情况。对角膜浸润、角膜水肿、角膜后沉着物进行评分,并对影响视力预后的相关因素进行统计学分析。结果治疗前,患者的BCVA为0.25±0.21;治疗后1周及治疗后1月BCVA分别为0.51±0.25和0.62±0.25,治疗前相比均有显著提高(t=5.153,9.365,P<0.01)。角膜浸润、角膜水肿,KP在轻度视力损害组、中度视力损害组和重度视力损害组各组间差异均具有统计学意义(P<0.01)。就诊时间和年龄与视力预后呈线性负相关(r=-0.78,-0.69,P<0.01)。结论角膜浸润、角膜水肿、KP以及葡萄膜炎都是评价病情轻重的体征指标,与视力预后密切相关。就诊时间、年龄因素为视力预后的相关因素。早期诊断、综合治疗可以有效地提高带状疱疹角膜炎的视力预后。

Objective： To investigate the clinical characteristics and treatment of herpes zoster keratitis（ HZK） and related factors of affect vision prognosis. Methods： The participants were 70 patients with herpes zoster keratitis in our hospital from January 2010 to June 2015. The treatment histories of 58 patients with complete records were retrospectively analysed.All patients received both systemic and topical ganciclovir combined with topical or systemic corticosteroid therapy according to the condition. Preventive antibiotics and artificial tears were administered in all cases. Best corrected visual acuity（ BCVA）,corneal infiltration,corneal edema and keratic precipitates were evaluated before and after the therapy at 1st and 4th week. The related factors affecting vision prognosis were analyed statistically. Results： Compared with the mean BCVA before treatment（ 0. 25 ± 0. 21）,the mean BCVA at 1st,4th week（ 0. 51 ± 0. 25,0. 62 ± 0. 25） were improved significantly（ t =5. 153,9. 365,respectively,P〈0. 01）. The intergroup differences of corneal infiltration,corneal edema and KP had statistical significance in mild visual loss group,moderate visual loss group and severe visual loss group（ respectively,P〈0. 01）.The results showed that it was negative linear correlation between vision prognosis and length of disease history,age（ r =-0. 78,-0. 69,P〈0. 01）. Conclusion： Corneal infiltration,corneal edema,uveitis and KP were evaluating factors of HZK,and were closely related to visual prognosis. Length of disease history and age were related factors of vision prognosis. Early diagnosis and comprehensive treatment can effectively improve the visual prognosis of HZK.