目的观察无环鸟苷对HSV-1角膜炎的治疗和预防复发作用.方法选用105例HSV角膜炎病人,将病人按临床表现分为4组,即上皮型、基质型、坏死型及HSV角膜炎行角膜移植及结膜瓣遮盖术,并对4组病人选用全身+局部无环鸟苷治疗.愈后将上皮质型和基质型患者随机分为2组,抗复发治疗组和对照组.治疗组给予口服预防量无环鸟苷300 mg/d,持续一年.对照组未给予任何药物. 结果上皮型经口服及局部点眼后96%痊愈.基质型给予口服加局部无环鸟苷点眼,同时给予激素滴眼治愈率为100%.坏死型经1000 mg/d无环鸟苷静脉应用,治愈率达33%,余穿孔行结膜瓣遮盖及角膜移植术,术后静脉应用无环鸟苷2周尽快控制病情,角膜植片及结膜与伤口愈合 .上皮质型和基质型的角膜炎治愈后持续应用无环鸟苷口服300 mg/d,随访1年,治疗组有5 例复发,对照组有14例复发,两组比较有显著的统计学差(P<0.01).结论无环鸟苷局部+全身治疗对HSV角膜炎有较好的治疗作用,低剂量长期口服对控制复发有良好的作用.随访期间未见全身及局部副作用.%Objective To evaluate the role of acyclovir in treatment and prevention of herpes simplex keratitis (HSK).Methods A total of 105 patients with HSK were divided into 4 groups. Group 1 consisted of 79 patients with HSV epithelial keratitis. Group 2 consisted of 20 patients with interstitial keratitis. Group 3 consisted of 6 patients with necrotizing keratitis. Group 4 consisted of 4 necrotizing keratitis patients with corneal perforation treated with conjunctival flap and corneal transplantation. All patie nts were treated with acyclovir systemically and topically. After full recove ry, the patients with epithelial HSK and stromal HSK were randomly divided into two groups individually. One group was constantly treated with oral acyclovir at 300 mg/day for 1 year as a prophylaxis group. The other group was designated as control. Results During the one-year treatment and follow-up, 5 cases with epithelial HSK recurred in the prophylaxis group and 14 cases in the control group, showing a statis tically significant difference. One case of stromal HSK recurred in the prophyl axis group and 4 recurred in the control group. Conclusion Long term and low dose oral acyclovir for prophylaxis of recurrent epithelial herpes simplex infection and therapeutic doses of oral acyclovir reduce both the rate and duration of recurrences of infectious herpes simplex keratitis.
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