Ormerod L D
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114.
Can J Ophthalmol. 1989 Apr;24(3):112-6.
The author evaluated 142 patients aged 65 years or older with microbial keratitis. There were relatively high rates of Pseudomonas aeruginosa infection unassociated with contact lens wear and of Streptococcus pneumoniae infection. The rates of quasicommensal and enteric infections were not proportionately elevated. Corneal disease, use of topical corticosteroids and use of contact lenses were the main predisposing factors. Patients with diabetes mellitus, dementia or chronic alcoholism appeared to be at higher risk. Trauma was rarely a factor. Complications requiring surgery were common. Corneal perforation developed in 20% of the patients, and endophthalmitis developed in 6%. The elderly often do not tolerate intensive topical antibiotic treatment well. Supplementary subconjunctival antibiotic injections under local anesthesia may be necessary. Corneal tissue glue, tarsorrhaphy and conjunctival flaps are probably underused in this age group.
作者对142例65岁及以上的微生物性角膜炎患者进行了评估。铜绿假单胞菌感染（与佩戴隐形眼镜无关）和肺炎链球菌感染的发生率相对较高。准共生菌和肠道感染的发生率没有相应升高。角膜疾病、局部使用皮质类固醇和佩戴隐形眼镜是主要的诱发因素。患有糖尿病、痴呆或慢性酒精中毒的患者似乎风险更高。外伤很少是一个因素。需要手术治疗的并发症很常见。20%的患者发生了角膜穿孔，6%的患者发生了眼内炎。老年人通常对强化局部抗生素治疗耐受性不佳。可能需要在局部麻醉下进行补充性结膜下抗生素注射。角膜组织胶水、睑裂缝合术和结膜瓣在这个年龄组中可能未得到充分利用。
