Lacrimal Duct Occlusion Is Associated with Infectious Keratitis.
Lacrimal Duct Occlusion Is Associated with Infectious Keratitis.
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泪道阻塞与感染性角膜炎有关
DOI：
10.7150/ijms.16515
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发表时间：
2016
影响因子：
3.6
通讯作者：
Zhu Y
中科院分区：
文献类型：
--
作者：
Li G;Guo J;Liu R;Hu W;Xu L;Wang J;Cai S;Zhang H;Zhu Y
背景：探讨感染性角膜炎患者泪道阻塞的发生率，以及泪道疏通术在人类感染性角膜炎治疗中的必要性。方法/原则研究结果：本设计为前瞻性、非对照病例系列。本研究包括28例持续性感染性角膜炎患者的31只眼。泪道冲洗试验判断有无泪道阻塞。感染性角膜炎的诊断依据是临床表现、角膜刮片镜检和细菌/真菌培养。病毒性角膜炎的诊断是基于复发史、深层新生血管和典型的角膜瘢痕外观。角膜炎的治疗方法包括药物、滴眼液或手术，而慢性泪囊炎的治疗方法是泪道疏通术和支撑管植入手术。在31只感染性角膜炎中，15只眼(48%)患真菌性角膜炎，2只眼(6%)患细菌性角膜炎，14只眼(45%)患病毒性角膜炎。10例感染性角膜炎患者11只眼(35%)同时伴有泪道阻塞。其中6只眼合并下泪小管阻塞，3只眼鼻泪管阻塞合并慢性泪囊炎，1只眼合并上、下泪小管阻塞，1只眼合并上泪小管阻塞。在局部和全身应用抗菌、抗病毒、抗真菌和抗炎药物后，28只眼(90%)在3周内痊愈，而3例患者的溃疡需要泪道疏通和支撑管植入手术才能愈合。结论：在此，我们首次报道了感染性角膜炎的流行与泪道阻塞的发生密切相关。当两者均被证实时，同时治疗角膜炎和泪道阻塞是必要的。有必要对该病的发病机制、预防和控制进行进一步评价。
Background: To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human infectious keratitis. Methodology/Principle Findings: The design is prospective, non-control case series. Thirty-one eyes from twenty-eight continuous patients with infectious keratitis were included in this study. The presence/absence of lacrimal duct obstruction was determined by the lacrimal duct irrigation test. The diagnosis of infectious keratitis was made based on clinical manifestations, cornea scraping microscopic examination and bacterial/fungus culture. Diagnosis of viral keratitis was set up based on the recurrent history, deep neovascularization and typical outlook of the cornea scar. The treatment of keratitis included drugs, eye drops or surgery, while treatment of chronic dacryocystitis was lacrimal duct dredging with supporting tube implantation surgery. In the thirty-one eyes with infectious keratitis, fifteen suffered from fungal keratitis (48%), two bacterial keratitis (6%), and fourteen viral keratitis (45%). Eleven eyes (35%) from ten patients with infectious keratitis also suffered from lacrimal duct obstruction. In those cases, six eyes also suffered from lower canalicular obstruction, three nasolacrimal duct obstruction and chronic dacryocystitis, one a combination of upper and lower canalicular obstruction, one upper canalicular obstruction. After local and systemic applications of anti-bacterial, anti-viral, anti-fungal and anti-inflammatory drugs, twenty-eight eyes (90%) recovered within three weeks, while the ulceration of three patients required the lacrimal duct dredging and supporting tube implantation surgery for the healing. Conclusions: Herein, we first report that the prevalence of infectious keratitis is closely correlated to the occurrence of lacrimal duct obstruction. When both confirmed, simultaneous treatment of keratitis and lacrimal duct obstruction promptly is required. Further evaluation of mechanism, prevention and control of the diseases are warranted.
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