摘要
目的分析总结放线菌性角膜炎的诊断及治疗方法。设计回顾性病例系列。研究对象5例(5眼)放线菌性角膜炎患者。方法回顾性分析2004年10月至2006年3月间明确诊断的5例放线菌性角膜炎患者的临床表现,实验室菌种鉴定及药物敏感性试验。主要指标临床特征、菌种鉴定、药敏分析。结果5例放线菌性角膜炎患者均为男性、农民,其中4例发病前有"迷眼"一角膜擦伤史,为该病主要危险因素,临床主要表现为慢性进行性角膜浅、中基质层溃疡,实验室检查明确诊断为奴卡菌性角膜炎4例,另1例为链霉菌感染。药敏试验显示阿米卡星、复方新诺明、庆大霉素及氟喹诺酮类为主要敏感抗生素,抗生素敏感性差异较大。治疗主要采用敏感抗生素频繁点眼,联合局部清创、5%碘酊烧灼,2例溃疡较深者予病灶切除联合羊膜覆盖术。结论放线菌性角膜炎多有"角膜擦伤"史,角膜刮片细胞学及细菌学检查可辅助明确诊断。对中重度患者强调药物、清创及手术相结合的综合治疗。
Objective To analyze clinical diagnosis and management of 5 patients with actinomycete keratitis. Design Retrospective case series. Participants 5 patients （5 eyes） with actinomycete keratitis. Methods The clinical features and microbiologic data of 5 culture-proven cases of actinomycete keratitis recorded between October 2004 to March 2006 were analyzed. Main Outcome Measures clinical characteristics, isolations identification, drug susceptibility test and treatments. Results All patients were males and farmers. Of the 5 cases presented in this study, 4 cases were followed by minor trauma as a predominant risk factor, and were presented by a chronic progressive corneal ulcer with a wreath pattern of infiltrate. The diagnosis of all cases was based on laboratory investigations, by which 4 cases of nocardia and one case of streptomyce were identified. A variable drug sensitivities were presented in nocardia isolates, which including TMP-SMZ, amicasin, gentamicin and fluorine-quinolones. Conclusions Nocardia keratitis is mainly followed by a minor trauma. It is identified predominantly by laboratory investigations. Tropical and systemically sensitive biotic are the initial choice, while debridement and amnionic transplantation could be an effective alternative.
出处
《眼科》
CAS
2007年第3期191-194,共4页
Ophthalmology in China
