摘要
目的探讨角膜层间感染的临床特征。方法回顾性病例系列研究。收集2018年1至12月因角膜移植手术或角膜屈光手术后角膜层间感染就诊于北京同仁眼科中心的8例患者(8只眼)资料,其中男性2例,女性6例,年龄18~55岁(中位数27岁)。记录患者的一般资料及其手术类型、发病时间、临床表现;采用活体角膜激光共聚焦显微镜(IVCM)等对病灶进行检查,并进行微生物培养及药物敏感性试验。结果8例患者中飞秒激光小切口角膜基质透镜取出术(SMILE)后4例,板层角膜移植术后2例,角膜内皮移植术后2例。术后发病时间为2~30 d,平均为9.8 d。3例SMILE术后患者的治疗转归为角膜斑翳或白斑,其余5例层间感染均需要行角膜移植手术。4例角膜移植术后层间感染的病原菌均为念珠菌属。IVCM镜下可见角膜层间细菌感染患者的角膜基质层内大量无正常组织结构的坏死组织,其间可见炎症细胞浸润,局部炎症细胞聚集,未见典型的病原体;真菌感染患者可见角膜帽下真菌菌丝(丝状真菌感染)或角膜层间密集的点状高反光结构(酵母样真菌感染)。结论角膜层间感染不易被早期诊断,预后较差,IVCM可辅助其早期诊断;角膜层间感染的病原谱与角膜外伤所致的角膜感染可能存在差异。
Objective To analyze the clinical features of corneal interface infection.Methods A retrospective case series study was conducted to explore the clinical features of interstitial corneal infection.The data of eight patients(eight eyes)who were diagnosed with interstitial corneal infection after undergoing corneal transplant or corneal refractive surgery and visited Beijing Tongren Eye Center from January to December 2018 were collected,including two male and six female patients aged between 18 and 55 years(median age,27 years).The patients′general information,surgical type,onset time,and clinical manifestations were recorded.The lesions were examined by in vivo corneal laser confocal microscopy(IVCM),and microbial cultures and drug sensitivity tests were performed.Results Among the 8 patients,4 had undergone small-incision lenticule extraction(SMILE),2 had undergone lamellar keratoplasty,and 2 had undergone endothelial keratoplasty.The onset of infection occurred between 2 and 30 days after surgery,with a mean of 9.8 days.Among the 3 patients who had undergone SMILE,the treatment outcome was corneal haze or opacity,while the remaining 5 cases required corneal transplantation for interstitial infections.The pathogens of the 4 cases of interstitial infection after corneal transplantation were all Candida species.Under the IVCM,patients with corneal interstitial bacterial infections showed a large amount of necrotic tissue with no normal tissue structure in the corneal stroma,with infiltration of inflammatory cells and local aggregation of inflammatory cells,but no typical pathogen was observed.Patients with fungal infections showed fungal hyphae under the corneal cap(filamentous fungal infection)or dense,punctate,high-reflection structures in the corneal interstitial space(yeast-like fungal infection).Conclusions Corneal interlayer infection is difficult to diagnose early and has a poor prognosis.IVCM can assist in early diagnosis.The pathogen spectrum of corneal interlayer infection may differ from that of corneal infection caused by trauma.
作者
张阳
王智群
邓世靖
陈可心
孙旭光
Zhang Yang;Wang Zhiqun;Deng Shijing;Chen Kexin;Sun Xuguang(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2023年第8期657-663,共7页
Chinese Journal of Ophthalmology
