【摘要】 目的：分析角膜溃疡的病例分布、危险因素、临床特点、微生物检查及预后结果。方法: 对200307/ 200604就诊于马来西亚大学医学中心的84例（87眼）患者进行研究，其中1例双眼发病，另1例曾因疱疹性角膜炎复发3次就诊。选入标准包括角膜上皮缺损、角膜基质浸润及炎症。 结果：患者84例中有男46例，女38例。主要是马来人(52%)。3个主要的危险因素是角膜接触镜的配戴(47%)，眼外伤(25%)及眼表疾病(24%)。在老年患者中，糖尿病(8%)及高血压(9%)是重要的系统性疾病。阳性为25%，而微生物培养阳性为73%。在各危险因素组中，绿脓杆菌是最常见的致病菌，在角膜接触镜配戴者中最高。耐庆大霉素革兰染色阴性菌有2例,耐青霉素表皮葡萄球菌有1例。75%的患者溃疡愈合，遗留角膜混浊。2mo后,54%的患眼最佳矫正视力>6/18，14%<3/60。3例患者需要行眼球摘除或剜除术。 结论：角膜接触镜配戴和眼外伤是青年人群中主要的可预防性危险因素，相反，眼疾是老年人中不可预防的危险因素。超过60%的培养阳性病例为革兰染色阴性菌。
【关键词】 角膜溃疡 角膜炎 马来西亚
INTRODUCTION
Retinoblastoma is the commonest primary intraocular malignant tumour in children. It usually presents before the age of 3 years[1]. It could be sporadic or familial. Familial cases tend to be bilateral and can be detected within 2 weeks after birth[2].
Part of the goal of managing retinoblastoma in the developed world include early detection and preservation of the eye with good vision[2,3]. The mortality from retinoblastoma is reported to be only 2%5%[1]. In many developing countries, however, due to late presentation poverty and inadequate facilities the goal of treatment is often to preserve life as the eye is almost invariably removed[4]. The current study examines the challenges in managing retinoblastoma in a developing country.
PATIENTS AND METHODS
The clinical and histopathological records of patients with retinoblastoma seen at University of Nigeria Teaching Hospital and Ebrans clinic both in Enugu, Nigeria over a 5year period (January 1998 to December 2002) were reviewed.
Data collected included patients age at diagnosis, sex, laterality, staging of tumour, family history and treatment modality. Data analysis was with EPIINFO version 6.0.
A four stage system of classification[5] was adopted for the study: 1)Quiescent stage with amaurotic cat eye reflex 2)Stage of increase of intraocular pressure. Tumour is confined to the eyeball but with glaucoma, megalocornea and intraocular inflammatory changes 3)Stage of extraocular extension involving the optic nerve. Spread is limited to the orbit 4)Distant metastasis to cervical lymph nodes, bones, central nervous system etc.
RESULTS
A total of 34 children had histologically proven retinoblastoma during the study period. Their age and sex distribution is shown in table 1. The earliest age at presentation was 5 months and the oldest age was 7 years. The mean age of males was 3.1±1.6 years and that of females was 2.4±1.2 years while overall mean age was 2.9±1.5 years. There was no statistically significant difference in the mean ages of males and females (t=1.2,P=0.3)
More males 25(74%) than females 9(26%) were affected, giving a male to female ratio of 1∶0.4. Only 6 patients had bilateral tumour. No positive family history of retinoblastoma was noted. The staging of the disease is as follows: stage 1, 3 patients (9%); stage 2, 8 patients (24%), stage 3, 13 patients (38%) and stage 4, 10 patients (29%).
Eleven patients (32.4%) had enucleation while 23 (67.6%) had exenteration. In the exenteration group, 5 patients presented earlier when the tumour was confined to the globe. Their parents, however, refused enucleation and only came back when tumour had spread to the orbit and became unsightly.
Postoperatively they were referred to paediatric oncology unit for chemotherapy.
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