共聚焦显微镜评价真菌性角膜炎清创术联合药物治疗的效果

摘要

目的 评价共聚焦显微镜动态观察真菌性角膜炎角膜清创术联合药物治疗的临床效果.方法 回顾性分析本院真菌性角膜炎19例(19只眼),均有植物外伤史.先行共聚焦显微镜观察,再行角膜刮片查真菌菌丝,比较二者检出率.将19例随机分成治疗组(9只眼)和对照组(10只眼),两组行角膜清创术及抗真菌药物,待共聚焦显微镜多次查病灶无真菌后,治疗组联合应用非甾体抗炎药,加用局部皮质类固醇滴眼治疗,对照组单纯给予抗真菌药物滴眼治疗,比较两组角膜上皮愈合平均时间和BCVA,运用共聚焦显微镜观察炎症细胞数量和角膜基质细胞变化.结果 19例中共聚焦显微镜检出真菌菌丝者17例,阳性率89.4％,角膜刮片检出者16例,阳性率84.2％,两者比较,差异无统计学意义(x2=0.230,P=0.631).治疗组角膜上皮愈合平均时间(12.1 ±2.4)d,对照组角膜上皮愈合时间为(15.1±3.2)d,两组愈合时间差异有统计学意义(t=-2.290,P=0.035).发现在治疗后1周、3周、1个月、3个月时间内,两组BCVA对比,观察组均较优差异均有统计学意义(P=0.0000 ～0.0020).两组行角膜溃疡清创术,用共聚焦显微镜动态观察,治疗组确定病灶未见真菌菌丝后,在抗真菌药物基础上联合非甾体抗炎药、另加局部皮质类固醇治疗,结果示炎症细胞数量明显减少,角膜基质细胞趋于正常.结论 真菌性角膜炎清创术后,运用共聚焦显微镜动态观察,确定无真菌菌丝,适当调整或加用皮质类固醇有助于控制炎症,加速炎症吸收,减轻炎症反应,促进上皮愈合.它是一种快速有效无损伤的活体检查方法,在真菌性角膜炎的诊断治疗和研究中有重要意义.%Objective To evaluate the clinical efficacy of debridement and medication for fungal keratitis by means of confocal microscopy.Methods The data of 19 eyes of 19 patients who had plant injury history and had been diagnosed as fungal keratitis were analysed retrospectively.The patients were examined by laser confocal microscopy firstly,and then by corneal scraping test to find fungal hyphae.The detection rates of two different methods were compared.The 19 patients were randomly divided into treatment group (9 eyes) and control group (10 eyes),and patients of both groups received conventional corneal debridement and antifungal agents.After confirming the lesions without fungal hyphae by repeated laser confocal microscopy examination,patients in the treatment group received corticosteroid,combined with non-steroidal anti-inflammatory medicine; patients in the control group was only given antifungal eye drops.The average corneal epithelial healing time,BCVA were measured and compared between the two groups.And the changes of the number of inflammatory cells and corneal stromal cells recorded by laser confocal microscopy.Results In the 19 eyes,fungal hyphae were detected on 17 eyes by confocal laser scanning microscopy,and the positive rate was 89.4％.16 eyes were detected by corneal scraping,and the positive rate was 84.2％.There was no statistically significant difference between them (x2 =0.230,P =0.631).The corneal epithelial healing time in treatment group was (12.1 ± 2.4) d,and it was (15.1 ± 3.2) d in control group,the difference was statistically significant (t =-2.290,P =0.035).The difference in the BCVA 1 week,3 weeks,1 month and 3 months after treatment between the two groups were statistically significant (P =0.0000 ～ 0.0020),the treatment group showed better BCVA.In the treatment group,after using corticosteroid combined with non-steroidal anti-inflamming medicine,the number of inflamming cell decreased significantly and the corneal stromal cells tended to be normal.Conclusion After debridement and no fungal hyphae confirmed by laser confocal microscopy,the corticosteroid can promote epithelial healing and reduce inflammation.Laser confocal microscopy is a fast,effective and non-invasive biopsy methods.It plays an important role in the diagnosis,treatment and research in fungal keratitis.