摘要
目的 分析始发于角膜深基质或内皮面的真菌感染的临床特征及其诊断与治疗效果.方法 回顾性病例系列研究.分析2009年1月至2015年6月因真菌性角膜炎在山东省眼科研究所青岛眼科医院住院的1 006例患者的临床资料,选择就诊时角膜上皮完整、角膜病灶位于深基质及内皮面的患者9例.其中男性6例,女性3例.年龄40～74岁,平均54.8岁.对9例患者的病史、致病诱因,体征,诊断经过,治疗经过及治疗效果进行总结分析.结果 5例患病前有植物性外伤病史,2例有非植物外伤史,2例无明显诱因.从患病到来我院就诊的时间均在3个月以上,平均7.9个月,最长为2年.临床表现主要为患眼红、痛反复发作,伴轻度视力下降.主要体征为角膜内皮面及深基质的白色混浊浸润,伴有内皮斑和前房炎性反应,角膜浅基质和上皮完整.5例患者在外院误诊为葡萄膜炎,给予糖皮质激素治疗;2例误诊为病毒性角膜炎,给予抗病毒药物及糖皮质激素治疗;2例误诊为细菌性角膜炎,给予抗生素治疗.来我院就诊时视力0.1者4例,0.3者1例,0.5者2例,0.6者2例.6例通过共焦显微镜检查查出角膜内皮面和深基质有菌丝,3例阴性.对这些患者给予了局部抗真菌药物滴眼,及结膜下、基质内、前房内注射伏立康唑治疗均无效,最终均进行了穿透性角膜移植术.术中取下的病变角膜真菌培养5例阳性,分别为链铬孢霉菌2例,无孢霉、疣状瓶霉、镰刀菌各1例.另外4例分别通过组织病理学检查、内皮斑10％KOH湿片镜检找到菌丝.结论 角膜后部真菌感染以角膜深基质浸润及内皮斑为主要表现.患者通常有植物外伤史,共聚焦显微镜检查是早期明确诊断的重要方法.抗真菌药物的渗透性差,药物治疗往往无效,病程迁延,最终仍需行穿透角膜移植术治疗.
Objective To evaluate the clinical features of retrocomeal fungal infection and the therapeutic effects.Methods This was a retrospective,noncomparative study of nine patients with retrocorneal fungal infection and an intact corneal epithelium treated at Qingdao Eye Hospital.The history,clinical features,diagnostic methods,pathogens and therapeutic effects were analyzed.Results Five patients had a history of trauma by plant,two had a non-plant injury,and two had unidentified reasons.The duration between the initial onset and the first visit to our hospital was 7.9 months （range,3 months to 2 years）.There was endothelial plaque and sometimes with white infiltration in the deep stroma,but the corneal epithelium remained integrated,and the anterior stroma was uninfected.The patients were misdiagnosed as uveitis,herpes simplex keratitis or bacterial keratitis in the other hospitals.Visual acuity was 20/200 in four eyes,20/60 in one eye,20/40 in two eyes,and 20/30 in two eyes.Fungal hyphae were detected by confocal microscopy in six eyes.All the eyes had poor response to the antifungal medication before penetrating keratoplasty was performed.The smear examinations of the corneal eudothelial plaque showed fungal hyphae in six eyes.Alternaria Nees,Apospory,Phialophora verrucosa,and Fusarium were identified.Conclusions Plant injury is the most common risk factor of retrocorneal fungal infection.Slow onset and no initially obvious symptoms may lead to delayed diagnosis and misdiagnosis.The diagnosis can be confirmed by confocal microscopy before surgery.The effect of antifungal medication is usually poor.
作者
程钧
翟华蕾
王君怡
谢立信
Cheng Jun Zhai Hualei Wang Junyi Xie Lixin(Qingdao Eye Hospital, Shandong Eye Institute, Qingdao 266071, China)
出处
《中华眼科杂志》
CSCD
北大核心
2017年第10期758-765,共8页
Chinese Journal of Ophthalmology
基金
国家自然科学基金青年基金项目（81500703）
关键词
角膜炎
眼感染
真菌性
角膜基质
内皮
角膜
角膜移植术
穿透性
Keratitis
Eye infections,fungal
Corneal stroma
Endothelium,corneal
Keratoplasty,penetrating
