【摘要】 目的：确定细菌性角膜溃疡的发病诱因，临床和微生物特性。方法：本研究涉及300例(300眼)临床上疑似微生物感染的角膜溃疡患者。通过病史回顾和裂隙灯检查获得病例资料。采用标准技术完成角膜刮片检查。取部分刮片样本加入100g/L的氢氧化钾液后，以及采用革兰氏和吉姆萨染色，再直接在显微镜下观察是否存在真菌、细菌和棘阿米巴。另一部分刮片样本直接接种在血琼脂、麦康基琼脂、巧克力琼脂和萨布罗琼脂表面。通过角膜刮片检查，细菌性角膜溃疡被确诊为化脓性角膜溃疡浸润和表层上皮细胞缺失伴细菌感染。对患者应用抗菌治疗。结果：在随访期间，因丢失而被排除的有60个病例。在剩下的240人中，被确诊为细菌性角膜溃疡的156人(65%)，大多数为男性(102眼)，年龄分布14～74岁。角膜溃疡位于角膜中央的96人(61.5%)，位于外周的60人(38.5%)。溃疡深度<1/3角膜厚度的82人(52.6%)。前房炎症为：Tyndall现象和浮游细胞1+～2+64人。角膜涂片中分离出细菌的有125人(80%)，其中69%为革兰氏阳性，39%为革兰氏阴性。革兰氏阴性菌感染患者伴有重症前房炎症(P=0.003)并且深度>2/3角膜厚度(P=0.001)。分离得到的最常见致病微生物为金黄色葡萄球菌。治疗后40%的患者视力恢复到入院时的水平甚至更好，其余60%的患者预后差。结论：细菌性角膜溃疡是一种严重的眼部感染性疾病，对眼部存在视力威胁，在治疗上仍具挑战性。快速分离细菌和眼部抗生素的应用是治疗此类疾病的关键。
【关键词】 细菌性角膜炎；植物性外伤；微生物
Abstract
AIM: To determine the predisposing factors, clinical and microbial characteristics of bacterial corneal ulcer.
METHODS: Three hundred patients (300 eyes) of clinically suspected microbial corneal ulcer were included in the study. Data was collected through history and slit lamp examination. Using standard techniques, corneal scraping was performed. A portion of each scraping was examined by direct microscopy for the presence of bacteria, fungi and acanthamoeba by using 100g/L potassium hydroxideand also by Gramand staining. Another portion was inoculated directly on the surface of solid media such as blood agar, MacConkey agar, chocolate agar and Sabouraud's agar. A bacterial corneal ulcer was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping examination and cured with antibacterial therapy.
RESULTS: Of the 300 patients, sixty were lost in follow up, they were excluded from study. Of the remaining 240, bacterial corneal ulcer was identified in 156 (65.0%) patients. The age of patients ranged from 14 to 74 (mean age of 48) years. Majority of them were male (102). Corneal localization of the ulcers was distributed as central in 96 (61.5%) patients and peripheral in 60 (38.5%) patients. Ulcer depth in 82 (52.6%) patients was less than 1/3 of corneal thickness. In 64 (41.0%) patients, anterior chamber inflammation was 1+ to 2+ Tyndall effect with 1+ to 2+ cells present. Bacteria were isolated in 125 (80.0%) patients from the corneal smears. Sixtynine percent of isolated bacteria were Grams positive, and 39% were Grams' negative. Gram negative bacteria were associated with severe anterior chamber inflammation (P=0.003) and depth more than 2/3 of cornea (P=0.001). The most frequent organism isolated was Staphylococcus aureus. Forty percent of patients had good visual outcome with visual acuity same or better than the level at admission. Among the others 60% patients, final outcome was poor.
CONCLUSION: Bacterial corneal ulcer is aserious ocular infectious disease that remains a therapeutic challenge and vision threatening ocular condition. Rapid isolation of bacteria and treatment with intensive ocular antibiotics represent decisive steps in the management of such pathologies.
KEYWORDS: bacterial keratitis; agriculture trauma; organism
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