重视真菌性角膜炎个性化手术治疗的研究

doi:10.3877/cma.j.issn.2095-2007.2018.01.001

真菌性角膜炎是由致病真菌感染引起的致盲率极高的一种角膜病变。真菌性角膜炎在我国发病率较高，临床上以农民、工人等弱势群体更为多见。由于就诊条件相对较差，导致病情延误，且因缺乏特异性的抗真菌药物，真菌性角膜炎的致盲率呈现出逐年上升趋势。故患者在临床确诊为真菌性角膜炎后，医师应及时给予药物治疗。若药物治疗无效时，应根据角膜炎病灶的位置、大小、深度、病情进展情况、真菌菌种培养结果及患者经济情况等多方面因素综合考虑，及时制定个体化的手术治疗方案，以达到最佳的预后效果。

关键词: 角膜疾病, 眼内感染, 真菌性, 角膜炎, 治疗

Fungal keratitis is a kind of keratopathy with high blindness caused by pathogenic fungi infection. The incidence of fungal keratitis in China is high, and more disadvantaged groups, such as farmers and workers, are more common in our country. The blindness rate of fungal keratitis is increasing year by year due to the relatively poor visiting condition and the delayed condition. The patients in the clinical diagnosis of fungal keratitis, should be given prompt medical treatment, if drug therapy, should be based on the location of the lesion, keratitis size, depth and the progress of the disease, fungal culture factors and the economic situation of patients considering surgical treatment timely, individualized, to to achieve the best prognosis.

Key words: Corneal disease, Intraocular infection, Fungal, Keratitis, Treatment

图1 真菌性角膜溃疡患者行前房注药术前后不同时间点裂隙灯显微镜检查的对比图像　A图为前房注药术前裂隙灯显微镜检查图；B　图为前房注药术后一周时裂隙灯显微镜检查图；C　图为前房注药术后1个月时裂隙灯显微镜检查图；D　图为前房注药术后3个月时裂隙灯显微镜检查图

图2 真菌性角膜溃疡患者行板层角膜移植术前后裂隙灯显微镜检查的对比图像　经共聚焦显微镜检查可见患眼真菌菌丝呈水平方向生长，故选择板层角膜移植术，A图为板层角膜移植术前裂隙灯显微镜检查图；B　图为板层角膜移植术后1个月时裂隙灯显微镜检查图

图3 真菌性角膜溃疡伴前房积脓患者穿透性角膜移植术前后不同时间点裂隙灯显微镜检查的对比图像经共聚焦显微镜检查可见患眼真菌菌丝呈垂直方向生长，故选择穿透性角膜移植术。A图为穿透性角膜移植术前裂隙灯显微镜检查图；B　图为穿透性角膜移植术后一周时裂隙灯显微镜检查图；C　图为穿透性角膜移植术后1个月时裂隙灯显微镜检查图；D　图为穿透性角膜移植术后6个月时裂隙灯显微镜检查图

图4 真菌性角膜溃疡伴前房积脓并行穿透性角膜移植术后真菌复发患者行眼球前段重建术前后裂隙灯显微镜检查的对比图像　A图为穿透性角膜移植术前裂隙灯显微镜检查图；B　图为穿透性角膜移植术后真菌复发裂隙灯显微镜检查图；C　图为眼球前段重建术后裂隙灯显微镜检查图，　达到了保住眼球的效果

图5 重症真菌性角膜溃疡患者自体结膜瓣遮盖术后行穿透性角膜移植术前后不同时间点裂隙灯显微镜检查的对比图像　A图为自体结膜瓣遮盖术后裂隙灯显微镜检查图；B　图为自体结膜瓣遮盖术后3个月时裂隙灯显微镜检查图，　此时结膜瓣稳定，但未行穿透性角膜移植术；C图为穿透性角膜移植术后1周时裂隙灯显微镜检查图；D　图为穿透性角膜移植术后3个月时裂隙灯显微镜检查图，　未发生排斥反应

图6 真菌性角膜溃疡穿孔患者自体结膜瓣遮盖术前后裂隙灯显微镜检查的对比图像　A图为自体结膜瓣遮盖术前裂隙灯显微镜检查图；B　图为自体结膜瓣遮盖术后裂隙灯显微镜检查图，　患者术后裸眼视力达到0.4

图7 真菌性角膜溃疡患者紫外光核黄素角膜胶原交联术前后裂隙灯显微镜和共聚焦显微镜检查的对比图像　1A、2A、3A图分别为为紫外光核黄素角膜胶原交联术前、术后1周及术后1个月时的裂隙灯显微镜检查图；1B　图为紫外光核黄素角膜胶原交联术前共聚焦显微镜检查图，　图中可见大量菌丝，2B图为紫外光核黄素角膜胶原交联术后1周时共聚焦显微镜检查图，　图中可见溃疡逐渐修复，菌丝逐渐减少，3B图为紫外光核黄素角膜胶原交联术后1个月时共聚焦显微镜检查图，　图中可见角膜溃疡基本愈合，共聚焦显微镜未见菌丝，仅见纤维瘢痕增生

图8 真菌性角膜溃疡患者紫外光核黄素角膜胶原交联术前后不同时间点裂隙灯显微镜检查的对比图像A图为紫外光核黄素角膜胶原交联术前裂隙灯显微镜检查图；B　图为紫外光核黄素角膜胶原交联术后1周时裂隙灯显微镜检查图；C　图为紫外光核黄素角膜胶原交联术后1个月时裂隙灯显微镜检查图；D　图为紫外光核黄素角膜胶原交联术后3个月时裂隙灯显微镜检查图；E　图为紫外光核黄素角膜胶原交联术后6个月时裂隙灯显微镜检查图；F　图为紫外光核黄素角膜胶原交联术后1年时裂隙灯显微镜检查图；G　图为紫外光核黄素角膜胶原交联术后2年时裂隙灯显微镜检查图；H　图为紫外光核黄素角膜胶原交联术后3年时裂隙灯显微镜检查图

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Pay attention to Study on individualized surgical treatment of fungal keratitis

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Pay attention to Study on individualized surgical treatment of fungal keratitis