Risk Factors, Clinical Features, and Outcomes of Recurrent Fungal Keratitis after Corneal Transplantation
Risk Factors, Clinical Features, and Outcomes of Recurrent Fungal Keratitis after Corneal Transplantation
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角膜移植后复发性真菌性角膜炎的危险因素、临床特征和结果
DOI：
10.1016/j.ophtha.2009.10.004
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发表时间：
2010-05-01
期刊：
影响因子：
13.7
通讯作者：
Li, Huiping
中科院分区：
文献类型：
--
作者：
Shi, Weiyun;Wang, Ting;Li, Huiping
目的：探讨角膜移植术后复发性真菌性角膜炎的危险因素、临床特点及治疗方法。设计：回顾性、干预性病例系列。研究对象：2000年1月至2008年10月在山东眼科研究所接受角膜移植的899例真菌性角膜炎患者（眼）。614例患者行穿透性角膜移植术（PK）， 285例行板层角膜移植术（LK）。方法：所有患者在角膜移植前均未接受局部及全身抗真菌药物治疗。在PK或LK时使用比感染区直径大0.5 mm的环钻。回顾性回顾每位患者的医疗记录。分析了引起复发的病原菌种类。总结其临床特点，包括复发时间、部位、症状、体征等。根据临床特点，为所有患者确定适当的局部和全身抗真菌治疗；部分患者还接受联合结膜下或眼内注射氟康唑。如果治疗失败，则进行结膜皮瓣或角膜移植术。主要观察指标：病原菌种类、临床特征及明显治疗效果。结果：57例（6.34%）角膜移植术后复发。PK组（6.79%）与LK组（5.96%）复发率差异无统计学意义（P = 0.883）。术前低视（10.90%）、角膜穿孔（12.00%）、角膜感染扩大至角膜缘（20.69%）、晶状体感染合并白内障囊外摘出（50%）者复发率较高
Purpose: To study the risk factors, clinical features, and treatment of recurrent fungal keratitis after corneal transplantation.Design: Retrospective, interventional case series.Participants: Eight hundred ninety-nine patients ( eyes) with fungal keratitis who underwent corneal transplantation at the Shandong Eye Institute between January 2000 and October 2008. Six hundred fourteen patients underwent penetrating keratoplasty (PK) and 285 patients underwent lamellar keratoplasty (LK).Methods: All patients failed to respond to topical and systemic antifungal drugs treatment before corneal transplantation. A trephine that was 0.5 mm larger in diameter than the infection area was used during PK or LK. Medical records of each patient were reviewed retrospectively. The species of pathogenetic fungi causing recurrence were analyzed. The clinical features, including recurrence time, position, symptom, and physical signs, were summarized. Based on clinical features, appropriate topical and systemic antifungal treatment was determined for all patients; some patients also received combined subconjunctival or intracameral injection of fluconazole. If there was treatment failure, a conjunctival flap or keratoplasty was performed.Main Outcome Measures: Species of pathogenetic fungi, clinical features, and apparent therapeutic effects.Results: Fifty-seven patients (6.34%) experienced recurrence after corneal transplantation. There was no difference between PK (6.79%) and LK (5.96%) in recurrence rate (P = 0.883). A higher rate of recurrences was found in those with preoperative hypopyon (10.90%), corneal perforation (12.00%), corneal infection expanding to limbus (20.69%), or lens infection with extracapsular cataract extraction (50%; P