慢性泪囊炎相关角膜溃疡的临床特征及治疗转归
Clinical characteristics and treatment outcomes of chronic dacryocystitis-related corneal ulcers
黄晴 1单凤梅 1李洁 1张晓玉 1鹿秀海 1王富华 1高华 1亓晓琳1
作者信息
- 1. 山东第一医科大学附属眼科医院(山东省眼科医院)山东第一医科大学(山东省医学科学院)山东省眼科研究所 山东省眼科学重点实验室 省部共建国家重点实验室培育基地,济南 250021
- 折叠
摘要
目的 分析慢性泪囊炎相关角膜溃疡的临床特征及治疗转归,为临床合理诊疗提供依据.方法 采用系列病例观察研究方法,纳入2016年1月至2020年1月于山东第一医科大学附属眼科医院诊断为慢性泪囊炎相关角膜溃疡患者31例31眼,平均年龄(53.0±10.8)岁.随访观察眼部临床特征、病原微生物检查及药物敏感试验、治疗及转归.结果 患者慢性泪囊炎病史平均(3.6±1.9)年,角膜溃疡多位于角膜周边部,形态呈圆形,边界清晰.角膜刮片培养阳性率为74.2％(23/31),19眼查见细菌,3眼查见真菌菌丝,1眼同时查见革兰阳性球菌及真菌菌丝.微生物培养阳性率为74.2％(23/31),20眼细菌培养阳性(革兰阳性球菌16眼,革兰阴性杆菌4眼),3眼真菌培养阳性.革兰染色阳性球菌对万古霉素、利福平、莫西沙星、左氧氟沙星敏感率分别为100％(16/16)、87.5％(14/16)、81.3％(13/16)、75.0％(12/16).所有患者均通过手术治疗慢性泪囊炎,其中22眼行鼻内镜下泪囊鼻腔造口吻合术,7眼行泪囊摘除术,2眼行泪道探通联合置管术.角膜溃疡深度＜1/3角膜厚度(CT)者9眼,其中6眼经药物治疗(10.8±3.2)d后溃疡愈合,3眼行角膜病损切除术;溃疡深度为1/3～2/3 CT者6眼,均行结膜瓣遮盖术;溃疡深度＞2/3 CT者16眼,其中6眼行板层角膜移植术,8眼行穿透性角膜移植术,2眼合并感染性眼内炎行眼内容物剜除术.结论 慢性泪囊炎相关角膜溃疡多位于角膜周边部,以革兰阳性球菌感染最为常见.轻症患者应用敏感抗生素治疗后角膜溃疡逐渐愈合,感染严重的患者需要根据角膜溃疡的深度选择合适的手术进行治疗.
Abstract
Objective To analyze the clinical characteristics and treatment outcomes of chronic dacryocystitis-related corneal ulcers and to provide a basis for the rational clinical diagnosis and treatment.Methods An observational case series study was performed.A total of 31 patients(31 eyes)diagnosed with chronic dacryocystitis-related corneal ulcers in Eye Hospital of Shandong First Medical University were enrolled from January 2016 to January 2020,with an average age of(53.0±10.8)years.The typical ocular signs,results of the etiological examination and microbial sensitivity test,treatment process and outcomes were analyzed.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Eye Hospital of Shandong First Medical University(No.20191020-1).Written informed consent was obtained from each subject before any medical examination.Results The average history of chronic dacryocystitis was(3.6±1.9)years.Corneal ulcers were mostly located in the peripheral cornea and had a rounded morphology with clear borders.The positive rate of corneal scraping was 74.2％(23/31),with bacteria in 19 eyes,fungal hyphae in 3 eyes,and both gram-positive cocci and fungal hyphae in 1 eye.The positive rate of microbial culture was 74.2％(23/31),with positive bacterial culture in 20 eyes(gram-positive cocci in 16 eyes and gram-negative bacilli in 4 eyes)and fungal growth in 3 eyes.The sensitivity rates of gram-positive cocci to vancomycin,rifampicin,moxifloxacin,and levofloxacin were 100％(16/16),87.5％(14/16),81.3％(13/16),and 75.0％(12/16),respectively.All patients were treated with surgery for chronic dacryocystitis,including 22 cases of endoscopic dacryocystorhinostomy,7 cases of dacryocystectomy,and 2 cases of lacrimal duct probing combined with intubation.Among the 9 cases with an ulcer depth of＜1/3 of the corneal thickness(CT),6 cases were cured after(10.8±3.2)days of drug treatment and 3 cases underwent corneal lesion resection.The 6 patients with an ulcer depth of 1/3-2/3 of the CT underwent conjunctival flap covering surgery.Among the 16 patients with an ulcer depth of＞2/3 of the CT,lamellar keratoplasty was performed in 6 cases,penetrating keratoplasty in 8 cases and evisceration in 2 cases with infectious endophthalmitis.Conclusions Chronic dacryocystitis-related corneal ulcers are mainly located at the periphery of the cornea,and gram-positive cocci infections are the most common pathogenic bacteria.In patients with mild symptoms,corneal ulcers heal gradually after treatment with sensitive antibiotics.For patients with severe infections,appropriate surgery should be selected according to the depth of the corneal ulcer.
关键词
泪囊炎/角膜溃疡/细菌/药物敏感试验/治疗预后Key words
Dacryocystitis/Corneal ulcers/Bacteria/Drug sensitivity test/Treatment outcomes引用本文复制引用
出版年
2024
NETL
NSTL
万方数据