The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal
The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal
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DOI：
10.1136/bjo.85.4.388
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发表时间：
2001-04-01
影响因子：
4.1
通讯作者：
Whitcher, JP
中科院分区：
文献类型：
--
作者：
Upadhyay, MP;Karmacharya, PC;Whitcher, JP
目的-确定加德满都谷地巴克塔普尔地区眼外伤和角膜溃疡的发病率，方法：对34902例患者进行为期2年的前瞻性随访，随访对象为81名初级眼保健工作者，他们将所有眼外伤和/或眼外伤后发生的溃疡病例，如果患者出现任何症状或感染，请前往巴克塔普尔当地三个二级眼科研究中心之一，由眼科医生进行检查、治疗和随访。所有眼外伤病例均在中心记录和治疗。经临床检查证实的角膜擦伤患者在受伤后48小时内没有角膜感染的迹象，被纳入本研究，并使用1%氯霉素眼药膏对受伤的眼睛进行治疗，每天3次，持续3天。角膜擦伤551例（789/10万年发病率）。临床记录的角膜溃疡数量为558例（799/100 000年发病率）。在442名符合条件的角膜擦伤患者中，424名（96%）愈合，无感染，284名在受伤后18小时内开始治疗的患者中没有一名发生溃疡。4的109例患者（3.7%）受伤后18-24小时出现感染，和14（28.6%）的49例患者出现24-48小时随后发展角膜溃疡。结论眼外伤和角膜溃疡是严重的公共卫生问题，发生在尼泊尔的流行比例。这项研究结论性地表明，在农村环境中，对角膜擦伤的患者，及时局部应用1%氯霉素眼用软膏可以预防创伤后角膜溃疡。如果在受伤后18小时内开始预防，则可获得最大益处。
Aims-To determine the incidence of ocular trauma and corneal ulceration in the district of Bhaktapur in Kathmandu Valley, and to determine whether or not topical antibiotic prophylaxis can prevent the development of ulceration after corneal abrasion.Methods-A defined population of 34 902 individuals was closely followed prospectively for 2 years by 81 primary eye care workers who referred all cases of ocular trauma and/or infection to one of the three local secondary eye study centres in Bhaktapur for examination, treatment, and follow up by an ophthalmologist. All cases of ocular trauma were documented and treated at the centres. Individuals with corneal abrasion confirmed by clinical examination who presented within 48 hours of the injury without signs of corneal infection were enrolled in the study and treated with 1% chloramphenicol ophthalmic ointment to the injured eye three times a day for 3 days.Results-Over the 2 year period there were 1248 cases of ocular trauma reported in the population of 34 902 (1788/100 000 annual incidence) and 551 cases of corneal abrasion (789/100 000 annual incidence). The number of clinically documented corneal ulcers was 558 (799/100 000 annual incidence). Of the 442 eligible patients with corneal abrasion enrolled in the prophylaxis study, 424 (96%) healed without infection, and none of the 284 patients who were started on treatment within 18 hours after the injury developed ulcers. Four of the 109 patients (3.7%) who presented 18-24 hours after injury developed infections, and 14 (28.6%) of the 49 patients who presented 24-48 hours subsequently developed corneal ulceration.Conclusions-Ocular trauma and corneal ulceration are serious public health problems that are occurring in epidemic proportions in Nepal. This study conclusively shows that post-traumatic corneal ulceration can be prevented by topical application of 1% chloramphenicol ophthalmic ointment in a timely fashion to the eyes of individuals who have suffered a corneal abrasion in a rural setting. Maximum benefit is obtained if prophylaxis is started within 18 hours after injury.