角膜光密度值评估和指导钱币状角膜炎药物治疗的临床观察

The evaluation of corneal densitometric value and the clinical observation of guiding the drug treatment of nummular keratitis

目的分析角膜地形图光密度值在钱币状角膜炎药物治疗过程中的变化特点以及对药物治疗的指导作用。方法回顾性病例研究。对2017年11月至2021年12月山东省眼科医院明确诊断的14例(21只眼)钱币状角膜炎进行随访,随访时间为6~15个月,平均(9.50±3.82)个月。观察钱币状角膜炎患者的临床表现、裸眼视力、角膜激光共焦显微镜的扫描图像特点、确诊前钱币状上皮下浸润存在时间与浸润消退所需用药时间的关系,以及钱币状角膜炎在药物治疗过程中角膜地形图光密度值的变化特点及其治疗转归。采用SPSS统计学软件分析。结果14例患者中男性6例(6/14),女性8例(8/14);年龄17~69岁,平均(39.00±14.9)岁;单眼发病7例(7/14),双眼发病7例(7/14);14例患者角膜上皮下浸润出现前均有流行性角膜结膜炎诊断,裂隙灯下角膜病变相似,表现为角膜上皮下浅基质层内有散在或密集的圆形钱币状浸润,荧光素染色阴性;确诊时裸眼视力(UCVA)均值(0.46±0.28),治疗8个月后UCVA均值(0.64±0.30)(P<0.05),治疗后患者裸眼视力有所提高,较治疗前差异有统计学意义;14例(21只眼)在确诊前角膜钱币状上皮下浸润存在时间(T1)为0.5~8个月,平均(2.51±2.11)个月,角膜浸润消退治疗所需时间(T2)2.5~10个月,平均(5.93±2.17)个月,相关系数0.082(P>0.05),钱币状角膜炎上皮下浸润存在时间与浸润消退治疗时间二者相关性无统计学意义;14例(21只眼)钱币状角膜炎患者治疗3个月、8个月后角膜光密度值平均值分别为(19.78±5.00)、(17.11±3.50);经治疗后,14例(21只眼)患者最终9例(13只眼)完全恢复透明(角膜光密度值<16),4例(7只眼)好转,无效1例(1只眼)。结论钱币状角膜炎是一种慢性上皮下浸润角膜炎,多为急性流行性角膜结膜炎的伴随体症。上皮下浸润存在时间与药物治疗消退时间二者相关性无差异统计学意义。角膜地形图光密度值可作为评估钱币状角膜炎在药物治疗过程中角膜混浊消退的客观指标。

Objective To analyze the changes of corneal topography optical density value in the process of drug treatment of nummular keratitis and its guiding effect on drug treatment.Methods Retrospective case study.14 cases(21 eyes)of nummular keratitis diagnosed in Shandong Eye Hospital from November 2017 to December 2021 were followed up for 6~15 months,with an average of(9.50±3.82)months.To observe the clinical manifestations,uncorrected visual acuity of patients with nummular keratitis,scanning image characteristics of corneal laser confocal microscope,the relationship between the existence time of nummular subepithelial infiltration before diagnosis and the time of medication required for infiltration to subside,and the drug treatment of nummular keratitis.Change characteristics of corneal topography optical density value during the process and its treatment outcome.SPSS statistical software was used for analysis.Results Among the 14 patients,there were 6 males(6/14)and 8 females(8/14);aged 17~69 years,with an average of(39.00±15.89)years old;7 cases(7/14)had unilateral disease,and 7 had bilateral disease(7/14);Epithelial keratoconjunctivitis diagnosed before corneal subepithelial infiltration in 14patients,Slit-lamp keratopathy is similar,showing scattered or dense round numismatic infiltrates in the superficial stromal layer of the cornea,negative fluorescein staining.The mean uncorrected visual acuity(UCVA)at diagnosis(0.46±0.28),and the mean uncorrected visual acuity(UCVA)after 8 months of treatment(0.64±0.30)(P<0.05).The uncorrected visual acuity of the patients improved after treatment,and the difference was statistically significant compared with that before treatment.14 cases(21 eyes)existed for 0.5~8 months(T1)of corneal nummular subepithelial infiltration before diagnosis,with an average of(2.51±2.11)months,and the time required for corneal infiltration to resolve(T2)was 2.5~10 months,the average(5.93±2.17)months,the correlation coefficient was 0.082(P>0.05),there was no significant correlation between the existence time of nummular keratitis subepithelial infiltration and the treatment time of infiltration regression.The mean values of corneal optical density after 3 months and 8 months of treatment in 14 patients(21 eyes)with nummular keratitis were(19.78±5.00)and(17.11±3.50),respectively.After treatment,9 cases(13 eyes)of 14 cases(21 eyes)finally recovered completely(corneal optical density value<16),4 cases(7 eyes)improved,and 1 case(1 eye)was ineffective.Conclusions Numismatic keratitis is a chronic subepithelial infiltrating keratitis,mostly associated with acute epidemic keratoconjunctivitis.There was no significant difference in the correlation between the existence time of subepithelial infiltration and the time of drug treatment subsidence.Corneal topography can be used as an objective indicator to evaluate the resolution of corneal opacity during drug treatment for nummular keratitis.