角膜接触镜相关感染性角膜炎20例临床特征

doi:10.3760/cma.j.cn115909-20200609-00250

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摘要目的：观察角膜接触镜相关感染性角膜炎的临床特征及治疗转归，以期对临床诊疗提供参考。方法：回顾性观察2009年7月到2019年6月因配戴角膜接触镜发生感染性角膜炎而住院的患者，收集并分析患者的高危护理行为、症状体征、角膜感染灶的特点、病原学检查结果、治疗经过以及病情转归。结果：共20例患者（23眼）纳入本研究，女12例，男8例，平均年龄21.4岁。连续数日配戴及自来水清洗镜片占高危护理行为的72%（8/11）。最常见的临床症状是眼异物感、疼痛、眼红及视力下降。溃疡位于视轴区及视轴旁区15眼（65%），位于周边区8眼（35%）。病原学检查阳性率为35%（8/23），4眼为棘阿米巴感染，其中2眼合并表皮葡萄球菌感染；3眼为铜绿假单胞杆菌感染；1眼为表皮葡萄球菌感染。16眼（70%）药物治愈，7眼（30%）手术联合药物治愈。治疗效果佳为8眼（35%），效果良好为9眼（39%），效果差为6眼（26%）。结论：连续数日配戴及自来水清洗镜片是引发接触镜感染的重要危险因素；溃疡好发于视轴及视轴旁区；棘阿米巴原虫及铜绿假单胞杆菌是感染最常见的病原体。经过及时合理的药物及手术治疗，多数可获得满意疗效。

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关键词 ：角膜接触镜, 感染性角膜炎, 高危因素, 临床特征, 治疗预后

Abstract： Objective: To observe the clinical presentation and outcomes of corneal contact lens-related infectious keratitis, in order to provide a reference for clinical diagnosis and treatment. Methods: Patients who were hospitalized from July 2009 to June 2019 due to contact lens-related infectious keratitis were retrospectively reviewed. The risk factors of lens care, symptoms and signs, characteristics of corneal infection focus, results of etiological examination, treatment process and prognosis of the patients were collected and analyzed. Results: A total of 20 patients (23 eyes) were included in the study, 12 females and 8 males, with an average age of 21.4. Seventy-two percent of high-risk lens care (8/11) were wearing lenses for several days and washing the lenses in tap water. The most common clinical symptoms were foreign body sensation, pain, redness and vision loss. The ulcer in 15 eyes was located in the optic axis and paraoptic areas, and 8 eyes in the peripheral area. The positive rate of etiological examination was 35% (8/23). Acanthamoeba infection was found in 4 eyes, including 2 eyes combined with staphylococcus epidermidis infection, 3 eyes with pseudomonas aeruginosa infection and 1 eye with staphylococcus epidermidis infection. Sixteen eyes were successfully treated with drugs, and 7 eyes were successfully treated by surgery combined with drugs. Treatment outcomes were excellent in 8 eyes (35%), good in 9 eyes (39%), and poor in 6 eyes (26%). Conclusions: Wearing lenses for several days and washing them in tap water are the important risk factors of contact lens infection. Ulcers mainly occur in the optic axis and paraoptic areas. Acanthamoeba and pseudomonas aeruginosa are the most common pathogens. After timely and reasonable drug and surgical treatment, most of the patients can obtain satisfactory results.

Key words： contact lens infectious keratitis risk factors clinical characteristics treatment outcome

收稿日期: 2020-06-09

PACS:

基金资助: 国家自然科学基金项目（81870639、82070923）；泰山学者计划项目（20150215、201812150）；山东第一医科大学“学术提升计划”人才项目（2019RC009）

通讯作者: 高华（ORCID：0000-0002-1326-6946），Email：hgao@sdfmu.edu.cn

引用本文:

张菊李晓晓刘明娜史伟云高华. 角膜接触镜相关感染性角膜炎20例临床特征[J]. 中华眼视光学与视觉科学杂志, 2020, 22(12): 922-927. Ju Zhang, Xiaoxiao Li, Mingna Liu, Weiyun Shi, Hua Gao. Clinical Presentation in Contact Lens-Associated Infectious Keratitis: A Study of Twenty Cases. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(12): 922-927. DOI: 10.3760/cma.j.cn115909-20200609-00250

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200609-00250 或 https://www.cjoovs.com/CN/Y2020/V22/I12/922

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