氯霉素滴眼液初始治疗铜绿假单胞菌性角膜炎对其预后的影响

Initial Treatment of Pseudomonas aeruginosa Keratitis with Topical Chloramphenicol and Effects on Prognosis

目的:确定初始使用氯霉素经验性治疗铜绿假单胞菌性角膜炎是否对其预后产生积极作用。方法:回顾性分析2014年1月至2019年12月大理白族自治州人民医院眼科细菌培养和鉴定为铜绿假单胞菌性角膜炎患者77例(77眼)。根据使用左氧氟沙星滴眼液前是否使用氯霉素滴眼液情况,分为氯霉素组和非氯霉素组,并记录开始使用左氧氟沙星滴眼液时患眼的溃疡面积、初始最佳矫正视力、最终最佳矫正视力,病程及并发症。结果:36.36%的患者在使用左氧氟沙星滴患眼前使用了氯霉素滴眼液,氯霉素组的溃疡面积更大(P<0.05),两组的初始最佳矫正视力和最终最佳矫正视力比较差异无统计学意义,氯霉素组的病程更长(P<0.05),氯霉素组和非氯霉素组出现角膜血管翳和角膜穿孔的比率分别为3.57%和2.04%,差异无统计学意义(P>0.05)。溃疡面积与初始最佳矫正视力无相关性(r<0.2),病程长短与溃疡面积、初始最佳矫正视力及最终最佳矫正视力有一定相关性(0.2<r<0.4)。最终最佳矫正视力与初始最佳矫正视力有较强的相关性(r>0.6)。结论:超过1/3的铜绿假单胞菌性角膜炎患者在使用左氧氟沙星滴眼液前使用了氯霉素滴眼液,使用氯霉素滴眼液并不提高患者的最终最佳矫正视力、缩短病程和减少并发症的发生。

Objective:To determine whether the initial use of chloramphenicol for empirical treatment of Pseudomonas aeruginosa keratitis has a positive effect on its prognosis.Methods:77 patients(77 eyes)from January 2014 to December 2019,bacterial cultured and identified as bacterial infection by Pseudomonas aeruginosa in the ophthalmology department of Dali Bai Autonomous Prefecture People s Hospital were retrospectively analyzed.According to the use of chloramphenicol eye drops before levofloxacin eye drops,they were divided into chloramphenicol group and non-chloramphenicol group.The ulcer area,the initial best corrected visual acuity,the final best corrected visual acuity,the course of the disease and the complications when starting to use levofloxacin eye drops were recorded in details.Results:36.36%of patients used chloramphenicol eye drops before levofloxacin drops.The ulcer area in the chloramphenicol group was larger(P<0.05),and the initial best corrected visual acuity and final best corrected visual acuity of the two groups had no statistically significant difference.The course of the disease was longer in the chloramphenicol group(P<0.05).The rates of corneal pannus and corneal perforation in the chloramphenicol group and non-chloramphenicol group were 3.57%and 2.04%,respectively(P>0.05).There was no correlation between the area of the ulcer and the initial best corrected visual acuity(r<0.2).The length of the disease has a certain correlation with the area of the ulcer,the initial best corrected visual acuity and the final best corrected visual acuity(0.2<r<0.4).The final best corrected visual acuity has a strong correlation with the initial best corrected visual acuity(r>0.6).Conclusion:More than 1/3 Pseudomonas aeruginosa keratitis patients used chloramphenicol eye drops before using levofloxacin eye drops,but using chloramphenicol eye drops did not improve the patient s ultimate corrective vision,shorten course,or reduce the incidence of complications.