摘要
目的探讨角膜移植术后植片继发真菌感染的原发病、发病时间、临床特征、主要致病菌及治疗方案的选择。方法回顾性系列病例研究。收集2005年10月至2016年1月间山东省眼科研究所青岛眼科医院收治的角膜移植术后植片发生真菌感染患者29例（34眼），其中男25例（86％），女4例（14％）。分析患者原发病、植片真菌感染与角膜移植间隔时间、发病月份、诱发因素、病灶特征、致病菌及治疗情况。数据采用配对秩和检验进行分析。结果发生角膜植片真菌感染的34眼中，25眼（74％）既往接受过穿透性角膜移植术（PKP），9眼（26％）接受板层角膜移植术（LKP）。术前原发病大多为感染性角膜炎（24眼，70％）。植片发生真菌感染与角膜移植间隔时间为l～144个月，平均（39．5±43．0）个月，其中9眼（26％）发生于术后6个月内，3眼（9％）发生于6-12个月。植片真菌感染发生时间多在9-11月（17眼，50％）。27眼（79％）真菌培养结果阳性，致病菌主要为镰刀菌（9眼，33％）和链格孢霉菌（6眼，22％）。29眼（85％）真菌感染灶局限于角膜植片，5眼（15％）同时累及角膜植片和植床。22眼（65％）位于植片中央及旁中央区，其中15眼病灶直径〉4mm，7眼≤4mm；12眼（35％）位于植片周边区，病灶长径均〈4mm。27眼选择药物联合手术治疗，4眼选择单纯药物治疗，3眼放弃治疗，自动出院。角膜移植术是最主要的手术治疗方式（16眼，59％），其次是眼内容剜除术或眼球摘除术（6眼，22％）。结论角膜移植术后植片真菌感染多发生于秋季农忙季节。致病菌以镰刀菌和链格孢霉菌为主。角膜移植术是治疗植片继发真菌感染的主要手术方式。早期诊断并及时治疗，可最大限度地降低角膜植片真菌感染对视功能的影响。
Objective To study the clinical characteristics, pathogens, and treatment of graft fungal infection after corneal transplantation. Methods Twenty-nine patients （34 eyes） who were diagnosed with a graft fungal infection after keratoplasty in Qingdao Eye Hospital, Shandong Eye Institute, from October 2005 to January 2016, were reviewed. Twenty-five male （86%） and 4 female patients （14%） were included in the retrospective, interventional case series study. Data for primary diseases before keratoplasty, onset time of graft fungal infection, risk factors, clinical characteristics, pathogens, and treatments were analyzed. The data were analyzed with a signed-rank test. Results Penetrating keratoplasty was performed on 25 patients （74%） and lamellar keratoplasty was performed on 9 patients （26%）. The most common primary disease before keratoplasty was infectious keratitis （24 cases, 700/0）. The average interval between keratoplasty and graft fungal infection was 39.5±43.0 months （1-144 months）. The grafts were infected by fungi within 6 months in 9 cases （26%） and within 6 months to one year in 3 cases （9%） postoperatively. Fungal infection occurred during September-November in 17 cases （50%）. Fungi were positively cultured in 27 cases （79%）, and the main pathogens were fusarium （9 cases, 33%） and ahernaria （6 cases, 22%）. Infected lesions were located only on the corneal grafts in 29 eases （85%） and host corneas were involved in five eases （15%）. Central or paracentral corneal ulcers were observed in 22 cases （65%）, including large ulcers （length 〉4 mm） in 15 cases and small ulcers （length ~〈4 mm） in 7 cases; and peripheral ulcers not bigger than 4 mm in length were seen in 12 cases. Twenty-seven cases selected drug therapy combined with surgical treatment, 4 cases chose simple drug therapy, and the other 3 cases （9%） declined surgeries and asked to be discharged from our hospital. The most common surgical scherne is keratoplasty （59%）, followed by evisceration or enucleation （22%）. Conclusion Infectious keratitis dominates the primary disease of corneal graft fungal infections, and most of them occurred in the autumn. Fusarium and alternaria are the main pathogens. Timely diagnosis and treatment can minimize the impact of graft fungal infections on patient vision.
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
2016年第12期751-756,共6页
Chinese Journal Of Optometry Ophthalmology And Visual Science
基金
国家自然科学基金青年项目（81500703）
山东省自然科学基金（ZR2015YL027）
关键词
角膜移植
眼感染
真菌性
植片感染
Corneal transplantation
Eye infection, fungal
Graft infection
