摘要
目的探讨穿透性角膜移植术（PKP）后植片溃疡形成的临床特点和相关危险因素。方法对1996年1月至2006年3月10年间我院收治的60例（49人）PKP后植片溃疡的病例进行回顾性分析,分别记录其术前原发病、溃疡发生原因及危险因素、溃疡临床特征、病原学检查、治疗和预后等。结果植片溃疡的原发病因最常见的为单纯疱疹病毒性角膜炎（HSK）,共18例（30%）,其次为眼表烧伤（15,25%）。溃疡形成的主要原因及危险因素是植片感染（22,36.7%）和眼表异常（14,23.3%）。溃疡发生的时间为术后20d至17y,平均20.2m,其中26例（43.3%）发生于术后半年内,48例发生于术后2y内,2y后发生率下降（12,20%）。溃疡形态多呈圆形或近圆形（49,81.7%）,多发生于植片周边（31,51.7%）,深达浅基质层者居多（37,61.7%）。病原学检查阳性者共22例（36.7%）,其中细菌18例,真菌3例,细菌混合棘阿米巴原虫感染1例,具体菌种以表皮葡萄球菌多见（7,31.8%）。采用药物或手术治疗后,54例（90%）植片溃疡被治愈,视力得以不同程度的恢复。结论HSK和眼表烧伤行PKP后易发生植片溃疡,植片感染是导致溃疡形成的首要原因,表皮葡萄球菌是常见的致病菌。应加强对PKP患者的术后随访,积极预防感染和控制眼表疾病能有效降低植片溃疡的发生。
Objective To investigate the clinical characteristics and related risk factors of graft ulceration after penetrating keratoplasty （PKP）.Methods Sixty eyes （49 patients） with graft ulceration after PKP from January 1996 to March 2006 were retrospectively reviewed. The parameters evaluated were primary indications of PKP; causes and risk factors, clinical characteristics, etiologic organisms, treatment and prognosis of ulceration. Results The leading primary indications for PKP were herpes simplex keratitis（HSK）（18, 30%） and ocular surface burns（15, 25%）.The main causes and risk factors for graft ulceration were graft infections（22, 36.7%） and ocular surface disorders（14, 23.3%）. The time interval between PKP and the onset of graft ulceration was averaged 20.2 months （range： 20 days to 17 years）. Twenty-six eyes （43.35%） developed ulceration within 6 months after PKP, and 48 eyes within 2 years. Most of these graft ulcers were round or oval（49, 81.7%）, present at the periphery of graft（31, 51.7%）, and involved superficial corneal stroma（37, 61.7%）. Etiologic examination of corneal scrapings were positive in 22 eyes（36.7%）, with bacterial organism in 18 eyes, fungus in 3 eyes, and mixed infection of bacterium and acanthamoeba in 1 eye. The most common isolated organism was Staphylococcus epidermidis （7/22, 31.8%）. Fifty-four eyes （80%） healed with visual improvement by medication or surgery. Conclusion Corneal grafts for HSK and ocular surface burns after PKP were predisposed to ulceration. Infection was the leading cause for graft ulceration, and Staphylococcus epidermidis was the most common pathogen. To prevent graft ulceration, every necessary precaution and close follow-up of the graft after PKP should be taken.
出处
《中国实用眼科杂志》
CSCD
北大核心
2007年第7期771-775,共5页
Chinese Journal of Practical Ophthalmology
