Gottsch J D, Gilbert M L, Goodman D F, Sulewski M E, Dick J D, Stark W J
Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Ophthalmology. 1991 Feb;98(2):146-9. doi: 10.1016/s0161-6420(91)32323-6.
The 193-nm excimer laser was used to ablate experimental septate fungal (Fusarium) and an atypical mycobacterial (Mycobacterium fortuitum) keratitis in an animal model. The infections were allowed to proceed for 24 and 72 hours. After incubation, ablation with a 193-nm excimer laser with 5.0-mm treatment zones was performed until all suppurative areas were treated. The corneas were excised, halved, homogenized, and plated. All cultures were negative in the 24-hour group. However, in those corneas in which the infections were allowed to proceed to 72 hours, post-treatment cultures were positive for both organisms. Histopathologic examination confirmed that 24-hour infections had been eradicated and that 72-hour infections had organisms present. Three of the eight eyes in the M. fortuitum group perforated during treatment, even though the treatment depth by computer preselection was only 150 microns. Excimer laser photoablation may be a useful technique to eradicate early, localized microbial infections. However, it is apparent that advanced infections with deep stromal involvement and suppuration cannot be eradicated using this technique. Because corneas may be perforated inadvertently during treatment, excimer laser treatment of infectious keratitis should be approached with caution and used for superficial and well circumscribed lesions.
在动物模型中，使用193纳米准分子激光消融实验性霉菌性（镰刀菌）和非典型分枝杆菌性（偶然分枝杆菌）角膜炎。感染分别持续24小时和72小时。孵育后，使用光斑直径为5.0毫米的193纳米准分子激光进行消融，直至所有化脓区域均得到治疗。切除角膜，切成两半，匀浆后接种培养。24小时组的所有培养物均为阴性。然而，在那些感染持续72小时的角膜中，治疗后的培养物显示两种微生物均呈阳性。组织病理学检查证实，24小时感染已被根除，而72小时感染仍有微生物存在。偶然分枝杆菌组的八只眼中有三只在治疗过程中发生穿孔，尽管通过计算机预选的治疗深度仅为150微米。准分子激光光消融可能是根除早期局限性微生物感染的一种有用技术。然而，显然使用该技术无法根除伴有深层基质受累和化脓的晚期感染。由于治疗过程中角膜可能会意外穿孔，因此准分子激光治疗感染性角膜炎应谨慎进行，且仅用于浅表且界限清楚的病变。
