【摘要】 目的：观察局部清创联合50g/L安尔碘稀释液冲洗治疗真菌性角膜炎的临床疗效。方法：对61例61眼真菌性角膜炎患者采取局部清创联合50g/L安尔碘稀释液冲洗结膜囊联合药物保守治疗，观察其治疗效果。结果：经过局部清创联合安尔碘冲洗药物治疗，轻度者治愈率100%，中度者78%，重度者27%。结论：局部清创联合安尔碘冲洗对轻中度真菌性角膜溃疡治疗效果较好，对重度者效果欠佳。
【关键词】 局部清创;安尔碘;冲洗;真菌性角膜炎
Clinical observation of treatment of fungal keratitis with local debridement combined with 50g/L anerdian type 3 disinfectant dilution used in conjunctival sac
ZhiWei Luo, JianNan Li, DeYong Jiang,Yong Cai, XiangYang Peng
BrightYard Eye Hospital of Hunan Province,Changsha 410011, Hunan Province, China
Correspondence to: ZhiWei Luo. BrightYard Eye Hospital of Hunan Province, Changsha 410011, Hunan Province, China. [email protected]
Received:20100628 Accepted:20100719
Abstract
AIM: To observe the effect of treatment of fungal keratitis with local debridement combined with 50g/L anerdian type 3 disinfectant dilution used in conjunctival sac and medication.
METHODS: Sixtyone patients 61 eyes were treated with local debridement combined with 50g/L anerdian type 3 disinfectant dilution used in conjunctival sac and medication and the effects were observed.
RESULTS: The cure rate was as the follows: of the mild 100%, of the moderate 78%, of the serious 27%.
CONCLUSION: The treatment result of local debridement combined with 50g/L anerdian type 3 disinfectant dilution used in conjunctival sac and medication is better for the mild and the moderate,yet not effective for the serious cases.
KEYWORDS: local debridement; anerdian; washing; fungal keratitis
Luo ZW, Li JN, Jiang DY, et al. Clinical observation of treatment of fungal keratitis with local debridement combined with 50g/L anerdian type 3 disinfectant dilution used in conjunctival sac. Int J
Ophthalmol(Guoji Yanke Zazhi) 2010;10(9):17431744
真菌性角膜炎是一种严重的感染性眼病，致盲率很高，多由角膜外伤，特别是植物性外伤后感染所致。近年来，由于抗生素、糖皮质激素等药物的使用，发病率逐年升高。目前受限于角膜供体的缺乏，大部分患者仍主要采取药物治疗。我院于2005/2009年对61例61眼真菌性角膜炎患者进行局部清创，50g/L安尔碘稀释液冲洗，联合抗真菌药物治疗，取得了较好的疗效。
1对象和方法
1.1对象
符合真菌性角膜炎诊断标准[1]61例61眼，男38例38眼，女23例23眼。左眼37眼，右眼24眼。年龄2～78岁。有明确植物性外伤史者47眼，原因不明者14眼，在他院滴用过抗生素药物49眼，其中既滴用抗生素眼液也滴用糖皮质激素眼液12眼。病程2～60d。
1.2方法
主要用药：结膜囊冲洗用药安尔碘Ⅲ型为皮肤黏膜消毒剂，由上海利康消毒高科技有限公司生产，主要成分：有效碘含量为4.4～5.7g/L，醋酸氯已定含量为0.9～1.1g/L，不含乙醇，适用于黏膜和创面消毒(稀释10～20倍)。临床分型[2]：轻度13眼，角膜溃疡面积<3mm2，深度<1/3角膜厚度，部分角膜水肿，无前房积脓，可见虹膜;中度39眼，角膜溃疡面积3～6mm2，深度1/3～2/3角膜厚度，角膜水肿范围较大，前房积脓，可见大部分虹膜;重度9眼，溃疡面积>6mm2 ，深度>2/3角膜厚度，角膜混浊水肿，前房可见渗出物及积脓，虹膜及后部结构窥不清。实验室检查：61眼中刮片检查可见真菌菌丝者38眼;真菌培养61眼，有真菌生长者43眼，其中隐球菌17眼，酵母菌9眼，曲霉菌6眼，镰刀菌11眼。治疗方法：爱尔卡因滴眼表面麻醉后行局部清创术，去除溃疡表面附着的分泌物、坏死物等，用生理盐水稀释成2.5g/L安尔碘溶液冲洗结膜囊。清创术轻度者1次/wk，中度者每3d 1次，重度者1次/d。所有患者安尔碘稀释液冲洗1次/d。两性霉素B针剂用灭菌注射用水配成2g/L的眼液点眼，开始剂量为1滴/次，1次/h，滴入结膜囊内。3～4d后改为1滴/次，每2h 1次。口服酮康唑片剂，同时使用10g/L阿托品液散瞳，重组人表皮生长因子滴眼液及重组牛碱性成纤维细胞生长因子眼用凝胶促进角膜上皮生长。
[1] [2] 下一页 |
