角膜移植术治疗真菌性角膜溃疡临床报告

Treatment of mycotic corneal ulcer with keratoplasty

目的 :探讨角膜移植术治疗真菌性角膜溃疡的手术适应证及其临床效果。方法 :对临床上经刮片或共焦显微镜检查 ,确诊为真菌性角膜溃疡和疑为真菌性角膜溃疡患者 ,给予局部及全身抗真菌治疗 ,对病情不能控制 ,角膜溃疡直径≥7mm的患者 55例 ,用甘油或干燥保存的角膜组织行角膜移植术 ,对术中取下的角膜做组织病理学检测。结果 :随访 3～ 6个月 ,55例 (55只眼 )均经一次手术有效控制角膜炎症 ,成功恢复角膜外形。视力有进步者 48例 ,其中视力可达 0 1～ 0 3者 1 6例。 55例真菌培养均阳性。经鉴定 ,镰刀菌属 35例 ,曲霉菌属 1 3例 ,烟曲菌属 2例 ,孢子菌属 2例 ,其它丝状菌属 3例。共焦显微镜检查 ,显示出无损伤 ,快速 ,阳性率高的优点。结论 :对真菌性角膜溃疡患者 ,及时应用甘油或干燥保存的角膜组织行手术治疗 ,不仅控制炎症 ,缩短病程 ,且为复明奠定基础 。

Objective:To evaluate the surgical indication and long term result of keratoplasty in treating mycotic keratitis.Methods:55 patients with corneal ulcer were diagnosed as mycotic keratitis,confirmed by scraping and confocal microscopy,and treated with antifungal drugs unsucessesfully.The corneal ulcers were more than 7mm in diameter.These patients were treated with keratoplasty using dehydrated cornea or cornea preserved in glycerin.The excised cornea ulcer tissues were sent for histopathologic examination.Results:55 patients were followed up for 3～5 months.The corneal ulcers were controlled with keratoplasty with the corneal shapes maintained.Visual acuities were increased in 48 patients,of whom there were 16 patients whose visual acuities were between 0 1～0 3 .Culture results of the samples were all positive:35 were fusarine infection,13 aspergillus infection,2 aspergillus fumigatus infection,2 sporothrix infection and 3 hyphomycete infection.The advantages of confocal microscope were lesion free,rapid,and sensitive.Conclusion:Using dehydrated cornea or cornea preserved in glycerin in keratopasty for patients with mycotic keratitis timely can control the mycotic keratitis;shortening the course of the disease and most patients can get a comparatively good visual acuity,so it is an important treatment for mycotic corneal ulcer.