板层角膜移植术治疗真菌性角膜溃疡的疗效及复发危险因素分析

Clinical Characteristics and Risk Factors of Postoperative Recurrence in Patients With Fungal Corneal Ulcer Treated with Lamellar Keratoplasty

目的:探讨板层角膜移植术(Lamellar keratoplasty,LKP)治疗真菌性角膜溃疡患者治疗后复发的临床特点及危险因素。方法:回顾性分析2017年7月-2022年1月在笔者医院进行治疗的215例(215眼)真菌性角膜溃疡患者临床资料,将采取传统药物治疗患者设为药物治疗组(n=85),采取LKP治疗患者设为手术治疗组(n=130),比较两组治疗前后1、3、6个月时视力状况及眼睑刺激症状消失时间。统计手术治疗组治疗后复发例数并设为复发组,余下未复发患者设为未复发组,统计分析复发患者复发时间、部位及病原体,分析影响手术治疗患者治疗后复发的危险因素。结果:治疗前两组裸眼视力(Uncorrected visual acuity,UCUA)、最佳矫正视力(Best corrected visual acuit,BCVA)比较差异不具有统计学意义(P>0.05);治疗后1、3、6个月手术治疗组UCUA、BCVA水平均高于药物治疗组(P<0.05);手术治疗组畏光、流泪消失时间均短于药物治疗组(P<0.05)。手术治疗组130例(130眼)中治疗后复发21例(21眼),占16.15%,复发时间以4~15 d为主,复发位置以上方角膜缘为主,病原体主要为镰刀菌属。通过比较复发患者与未复发患者基线资料并将具有统计学意义的指标纳入Logistic回归分析,结果显示病程>1个月、居住在农村、农民、有前房积脓及治疗前接受糖皮质激素治疗为角膜溃疡治疗后复发的独立危险因素(P<0.05)。结论:对真菌性角膜溃疡患者予以LKP可更有效提高患者视力,促进疾病治愈,但治疗后仍有部分患者可复发,复发时间多在早期,病原体多为镰刀菌属,其中治疗前病程长、居住在农村、农民、有前房积脓及治疗前接受糖皮质激素治疗为治疗后疾病复发的危险因素,临床针对上述因素的患者应重点关注。

Objective To investigate the clinical characteristics and risk factors of postoperative recurrence in patients with fungal corneal ulcer treated with lamellar keratoplasty(LKP).Methods Clinical data of 215 patients(215 eyes)with fungal corneal ulcer who were treated in the author's hospital from July 2017 to January 2022 were analyzed retrospectively.Patients treated with traditional drugs and those treated with LKP were defined ass the drug treatment group(n=85)and the surgical treatment group(n=130).Visual acuity before operation and at 1 month,3 months and 6 months after operation and the disappearance time of eyelid irritation symptoms were compared between the two groups.Patients with recurrence in the surgical treatment group were included in the recurrence group,and the remaining were included in the non-recurrence group.The time,location and pathogen of recurrence were statistically analyzed.The risk factors for postoperative recurrence were analyzed.Results There was no statistically significant difference in uncorrected visual acuity(UCVA)or best corrected visual acuity(BCVA)between the two groups before treatment(P>0.05).UCVA and BCVA of the surgical treatment group at 1 month,3 months and 6 months after operation were significantly higher than those of the drug treatment group(P<0.05).The disappearance time of photophobia and lacrimation in the surgical treatment group was shorter than that in the drug treatment group(P<0.05).In the surgical treatment group,21 patients(21 eyes)(16.15%)experienced postoperative recurrence,and the recurrence time ranged from 4 d to 15 d.Recurrence mainly occurred on upper corneal limbus,and was mainly caused by Fusarium.Logistic regression analysis results showed that course of disease>1 month,living in rural areas,farmers,hypopyon and preoperative glucocorticoid treatment were independent risk factors for postoperative recurrence of corneal ulcer(P<0.05).Conclusion LKP can improve vision and promote recovery of patients with fungal corneal ulcer more effectively.However,some patients have recurrence after operation.Recurrence mainly occurs in early stage and Fusarium is the main pathogen.Long course of disease,living in rural areas,farmers,hypopyon and preoperative glucocorticoid treatment are risk factors for postoperative recurrence.Clinically,attention should be paid to patients with these factors.