Therapeutic keratoplasty for advanced suppurative keratitis
Therapeutic keratoplasty for advanced suppurative keratitis
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DOI：
10.1016/j.ajo.2007.01.015
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发表时间：
2007-05-01
影响因子：
4.2
通讯作者：
Tan, Donald T. H.
中科院分区：
文献类型：
--
作者：
Ti, Seng-El;Scott, Angus;Tan, Donald T. H.
目得：为了确定适应症，治疗成功，和角膜移植技术先进的医学不受控制的感染性keratitis.DESIGN：回顾性，干预性casesseries.METHODS：92例连续患者（1991年至2002年）谁接受治疗性角膜移植急性感染性角膜炎在新加坡国家眼科中心进行审查。病原体（S）进行了鉴定和结果进行了评价感染治愈（治疗成功），移植物清晰度，和visual acuity.Results：铜绿假单胞菌（58.7%）和镰刀菌属（32.3%）的细菌和真菌性角膜炎，分别占主导地位的生物。角膜移植术类型包括穿透性角膜移植术（PK; n = 80）和板层角膜移植术（n = 12）。平均移植物直径为9.5 mm（范围：5.5 - 14 mm）。74例（80.4%）经一次角膜移植术后治愈，3例经二次角膜移植术后治愈。寿命表生存分析计算出细菌性和真菌性角膜炎的1年治疗生存率分别为76.6%和72.4%（P = 0.76）。PK光学清晰度的Kaplan-Meier 1年生存率为72%。22例患者因各种原因（光学，n = 8;复发性原发感染，n = 7;穿孔或后续新发感染，n = 7）接受了重复角膜移植术。在15名治疗失败的患者中，11名患有真菌性角膜炎。感染复发时间为4天至1年。大多数复发（n = 11）出现在术后6周内。结论：治疗性角膜移植术可以有效地治疗严重的，难治性感染性角膜炎。高治愈率是可以实现的，尽管长期治疗后感染复发仍然是真菌性角膜炎的一个重要问题。
PURPOSE: To determine indications, therapeutic success, and corneal transplantation techniques for advanced medically uncontrolled infectious keratitis.DESIGN: Retrospective, interventional case series.METHODS: A review of 92 consecutive patients (1991 to 2002) who underwent therapeutic keratoplasty for acute infectious keratitis performed at Singapore National Eye Centre. Causative organism(s) were identified and outcomes were evaluated in terms of infectious cure (therapeutic success), graft clarity, and visual acuity.RESULTS: Pseudomonas aeruginosa (58.7%) and Fusarium species (32.3%) were the predominant organisms for bacterial and fungal keratitis, respectively. Keratoplasty types included penetrating keratoplasty (PK; n = 80) and lamellar keratoplasty (n = 12). Mean graft diameter was 9.5 mm (range, 5.5 to 14 mm). Seventy-four patients (80.4%) achieved therapeutic success after one kerato, plasty procedure, three patients were cured after a second keratoplasty. Life-table survival analysis computed the one,year therapeutic survival for bacterial and fungal keratitis as 76.6% and 72.4%, respectively (P = .76). The Kaplan-Meier one,year survival rate for PK optical clarity was 72%. Twenty-two patients underwent repeat keratoplasty for various reasons (optical, n = 8; recurrent primary infection, n = 7; perforation or subsequent new infections, n = 7). Of the 15 patients for whom therapy failed, 11 had fungal keratitis. Infection recurrence time was four days to one year. Most recurrences (n = 11) appeared within six weeks after surgery.CONCLUSIONS: Therapeutic keratoplasty may treat severe, refractory infectious keratitis effectively. High cure rates are achievable, although infection recurrence despite prolonged treatment remains a significant problem in fungal keratitis.