神经营养性角膜炎46例临床分析

A clinical analysis of 46 cases of neurotrophic keratitis

目的探讨神经营养性角膜炎(NK)的临床特征及诊疗特点。方法回顾性系列病例研究。收集2013年5月至2016年7月间在北京市同仁医院眼科门诊临床诊断为NK的患者46例(48只眼),其中男性26例(26只眼),女性20例(22只眼),年龄(51±18)岁。对患者一般情况、病因、眼部临床症状和体征、病程分期及疗效进行分析,总结NK患者的临床特征。25例患者(26只眼)应用Cochet-Bonnet角膜知觉检测仪测量角膜知觉,分析角膜知觉与临床分期的相关性。对不同程度NK的患者分布特征进行χ2检验。对角膜神经灵敏度和疾病临床分期行Spearman相关性分析。结果44例NK患者为单眼发病(95.65%),2例(4.35%)为双眼发病。18~29岁的患者4只眼,占8.33%;30~59岁的患者23只眼,占47.92%;≥60岁的患者21只眼,占43.75%。NK患者中,临床分期为Ⅰ期8只眼(16.67%);Ⅱ期21只眼(43.75%);Ⅲ期19只眼(39.58%)。3个年龄段患者各临床分期情况比较,差异无统计学意义(χ2=2.452,P=0.658)。NK最常见的病因为病毒感染17只眼(35.42%)、神经外科手术并发症11只眼(22.92%)和糖尿病10只眼(20.83%)。26只眼角膜知觉值在0~3 cm范围内,角膜知觉与临床分期无明显相关性(r2=0.284,P=0.753)。患者平均随访7个月,34只眼(70.83%)采用保守治疗,8只眼(16.67%)最终手术治疗,6例(6只眼)失访。结论NK可发生于各年龄人群,主要为中、老年人,且临床表现多样,如不及时诊治,常会引起角膜溃疡。角膜知觉与病变临床分期无明显相关性。早期诊断和针对性分期治疗对保护患者视功能十分重要。

Objective To investigate the clinical characteristics and therapeutic effect of neurotrophic keratitis(NK).Methods A retrospective case series study.A total of 46 patients(48 eyes)with clinically diagnosed NK in Beijing Tongren Hospital from May 2013 to July 2016 were analyzed,including 26 males(26 eyes)and 20 females(22 eyes),aged(51±18)years.The general condition,etiology,clinical features,stage of disease and curative effect of NK patients were summarized.Corneal sensation was measured by Cochet-Bonnet corneal sensor for 25 patients(26 eyes),and the correlation between corneal sensation and clinical staging was analyzed.Theχ2 test was performed on the distribution characteristics of patients with different clinical stages of NK.Correlation analysis of corneal sensation and the disease stage was performed using Spearman correlation analysis.Results Forty-four cases of monocular disease(96.65%)and 2 cases(4.35%)of bilateral disease were enrolled.Four eyes(8.33%)were from young patients(aged 18-29 years),23(47.92%)were from middle-aged patients(aged 30-59 years),and 21(43.75%)were from elderly patients(aged≥60 years).The disease was at stageⅠin 8 eyes(16.67%),at stageⅡin 21 eyes(43.75%),and stageⅢin 19 eyes(39.58%).There was no significant difference in clinical staging between the three age groups(χ2=2.452,P=0.658).The most common cause of NK was virus infection(17 eyes,35.42%),followed by neurosurgical sequelae(11 eyes,22.92%)and diabetes in 10 eyes(20.83%).Corneal sensation of 26 eyes ranged from 0-3 cm.There was no significant correlation between clinical stage and corneal sensation(r2=0.284,P=0.753).The patients were followed up for an average of 7 months.Thirty-four eyes(70.83%)received conservative treatment,and 8 eyes(16.67%)had surgery.Six patients(6 eyes)were lost for follow-up.Conclusions NK can occur in all ages,mainly in the elderly.The clinical manifestations are diverse.If time delays in the diagnosis and treatment,it often causes corneal ulcers.There is no significant correlation between corneal sensation and clinical stage.Early diagnosis and targeted treatment are important for protecting patients′visual function.(Chin J Ophthalmol,2020,56:274-298)