前节OCT辅助准分子激光治疗性角膜切削术治疗真菌性角膜溃疡

发布时间：2019-04-10 07:36

【摘要】：目的评价前节OCT辅助准分子激光治疗性角膜切削术(excimer laser phototherapeutic,PTK)治疗真菌性角膜溃疡的临床效果。方法回顾性分析已确诊为真菌性角膜溃疡且应用局部和全身抗真菌药物治疗7d后无效或病情加重的24例(24眼)患者,角膜溃疡深度均未超过1/3角膜厚度,将患者分为两组,治疗组接受前节OCT辅助的PTK治疗,共14例(14眼),对照组采用角膜病灶板层切除手术治疗,共10例(10眼)。随访至少6个月。记录治疗前后最佳矫正视力(best corrected visual acuity,BCVA)、角膜厚度、共焦显微镜检查情况。观察术后角膜上皮修复时间、治疗时间及并发症情况。结果两组术后BCVA均较术前明显提高,差异均有统计学意义(均为P0.01),治疗组BCVA提高程度明显优于对照组,差异有统计学意义(P0.05)。治疗组术后治疗持续时间为(19.43±5.68)d,短于对照组的(34.40±5.38)d,差异有统计学意义(P0.05)。治疗组术后剩余角膜厚度与对照组相比差异无统计学意义(P0.05)。共焦显微镜检查亦治疗组术后残余菌丝较对照组明显减少。治疗组术后上皮修复时间为(4.00±1.11)d,短于对照组的(6.20±1.39)d,差异有统计学意义(P0.05)。随访期内,治疗组术后无一眼复发,对照组术后0.5 a有3眼复发,1眼药物控制有效,另2眼病情加重,进一步行角膜移植手术。结论前节OCT辅助PTK治疗真菌性角膜溃疡可以有效清除病灶、加速上皮愈合,为治疗早期浅层真菌性角膜溃疡提供了一个全新的选择。
[Abstract]:Objective to evaluate the clinical effect of anterior segment OCT assisted excimer laser therapeutic keratectomy (excimer laser phototherapeutic,PTK) in the treatment of fungal corneal ulcer. Methods Twenty-four patients (24 eyes) who had been diagnosed as fungal corneal ulcer and treated with local and systemic antifungal drugs for 7 days were retrospectively analyzed. The depth of corneal ulcer was less than 1? 3? The patients were divided into two groups. 14 patients (14 eyes) were treated with OCT-assisted PTK in the treatment group, and 10 patients (10 eyes) were treated with lamellar keratectomy in the control group. All patients were followed up for at least 6 months. The best corrected visual acuity (best corrected visual acuity,BCVA), corneal thickness and confocal microscope were recorded before and after treatment. The corneal epithelial repair time, treatment time and complications were observed. Results the postoperative BCVA of the two groups was significantly higher than that of the pre-operation, the difference was statistically significant (P0.01). The improvement of BCVA in the treatment group was significantly better than that in the control group, and the difference was statistically significant (P0.05). The duration of postoperative treatment in the treatment group was (19.43 卤5.68) days, which was shorter than that in the control group (34.40 卤5.38) days, the difference was statistically significant (P0.05). There was no significant difference in residual corneal thickness between the treatment group and the control group (P0.05). Confocal microscopy also showed that the residual hyphae in the treatment group were significantly less than those in the control group. The time of epithelial repair in the treatment group was (4.00 卤1.11) days, which was shorter than that in the control group (6.20 卤1.39) days, the difference was statistically significant (P0.05). During the follow-up period, no recurrence occurred in the treatment group, 3 eyes in the control group recurred 0.5 years after operation, 1 eye was effective in drug control, and the other 2 eyes were more severe. The corneal transplantation was further performed in the treatment group. Conclusion the treatment of fungal corneal ulcer with anterior segment OCT and PTK can effectively clear the lesion and accelerate the epithelial healing, which provides a new choice for the treatment of early superficial fungal corneal ulcer. [WT5 "HZ] conclusion [WT5" BZ] [WT5 "BZ]
【作者单位】：大连医科大学附属大连市第三人民医院眼科;
【分类号】：R779.6

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