角膜胶原交联治疗真菌性角膜溃疡的临床疗效

doi:10.3760/cma.j.cn115909-20190916-00249

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摘要目的：探讨角膜胶原交联术在治疗真菌性角膜溃疡的可行性及临床疗效。方法：回顾性系列病例研究。收集2011年11月至2017年12月于厦门大学附属厦门眼科中心住院治疗的真菌性角膜溃疡患者82例（82眼），在联合用药无效或效果不佳的情况下行角膜胶原交联术。术后观察指标包括患者的主观症状、角膜溃疡愈合情况、视力恢复情况，共聚焦显微镜检查角膜溃疡情况。结果：所有患者术后观察时间为6个月至3年，角膜溃疡逐渐愈合形成不同程度瘢痕71例（愈合率87%），其中视力提高且不需要再次手术患者52例；病情仍然进一步加重，急性期行角膜移植手术患者8例，急性期行自体结膜瓣遮盖术患者1例；溃疡稳定但再次复发加重并行角膜移植术患者2例。结论：角膜胶原交联术是真菌性角膜溃疡新的治疗方法，且其联合药物治疗真菌性角膜溃疡简单、安全、有效。

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关键词 ：角膜胶原交联术, 核黄素, 真菌性角膜溃疡, 治疗效果

Abstract：Objective: To evaluate whether corneal collagen cross-linking improves the outcome of fungal keratitis. Methods: This was a retrospective clinical study. Patients (n=82) with fungal infected eyes were treated at Affiliated Xiamen Eye Center of Xiamen University, from November 2011 to December 2017. Corneal cross-linking was performed using the standard protocol after a multi-antifungal drug treatment failed to resolve the infection in patients. Main outcome measures: Clinical symptoms and corneal healing were examined using a slit lamp biomicroscope and an in vivo laser confocal microscope. Visual acuity improvement was also evaluated. Results: After 6 months to 3 years of follow-up, corneal scars eventually developed in 71 of 82 eyes. In 52 of 82 eyes, visual acuity improved. However, corneal melting was exacerbated and uncontrolled in 8 patients who immediately underwent corneal transplant surgery. In one patient, self-conjunctival transplantation was performed, and two others received a therapeutic corneal transplant due to recurrent inflammation and melting. Conclusions: Our results demonstrate that corneal collagen cross-linking is an effective procedure to manage patients afflicted with fungal keratitis.

Key words： corneal collagen crosslinking riboflavin fungal keratitis therapy outcome

收稿日期: 2019-09-16

基金资助:国家自然科学基金（81570815、81570816）；福建省自然科学基金（2015D013）；福建省医学创新课题项目（2014-CXB-50）；福建省卫生计生青年科研课题（2017-2-117）；厦门市科技惠民计划（3502Z20174003）；厦门市科技局重大科技创新平台项目（2013S0226）

通讯作者: 吴护平（ORCID：0000-0002-9683-1620），Email：wuhuping123@163.com

引用本文:

罗顺荣　吴护平　林志荣. 角膜胶原交联治疗真菌性角膜溃疡的临床疗效[J]. 中华眼视光学与视觉科学杂志, 2020, 22(8): 568-574. Shunrong Luo, Huping Wu, Zhirong Lin. Collagen Cross-Linking for the Treatment of Fungal Keratitis. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(8): 568-574. DOI: 10.3760/cma.j.cn115909-20190916-00249

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20190916-00249 或 https://www.cjoovs.com/CN/Y2020/V22/I8/568

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