Zhang Qi, Zhao Min, Xu Mei, Gu Fengjuan, Liu Quan, Chen Yuan, Zhang Haiqi, Kijlstra Aize
The First Affiliated Hospital of Chongqing Medical University, Department of Ophthalmology, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People's Republic of China.
Chongqing Vision Institute, Chongqing, People's Republic of China.
Infect Drug Resist. 2019 Aug 12;12:2487-2493. doi: 10.2147/IDR.S204025. eCollection 2019.
This study aimed to evaluate the outcomes of therapeutic keratoplasty for severe infectious keratitis in Chongqing (Southwest China).
The records of 561 eyes that underwent therapeutic keratoplasty for refractory microbial keratitis from 2001 to 2016 were analyzed in this retrospective study. Data included demographic information, microbiological investigations, associated factors, graft size, preoperative status, postoperative complications, and final anatomical outcomes.
Trauma was the most common cause (267, 47.6%) for corneal ulcers leading to therapeutic keratoplasty. The etiological diagnosis included bacterial keratitis (80 eyes, 14.3%), fungal keratitis (317 eyes, 56.5%), acanthamoeba keratitis (3 eyes, 0.5%), and mixed bacteria/fungal infection (15 eyes, 2.7%). Anatomical success was achieved for 492 eyes (87.7%), with bacterial keratitis having a better outcome than fungal and mixed infections. Diabetes and preoperative time ≥30 days were significantly associated with anatomical failure in the multivariate logistic regression (=0.028 and =0.022, respectively). Patients with hypopyon, corneal perforation, surgical delay, and/or large graft size had a higher incidence of postoperative complications (reinfection, cataract, glaucoma, hyphema, or graft rejection) (<0.05).
Therapeutic keratoplasty was an effective procedure in managing refractory infectious keratitis. Prompt and appropriate surgery would result in fewer complications and better outcomes.
本研究旨在评估中国西南部重庆地区严重感染性角膜炎治疗性角膜移植术的疗效。
本回顾性研究分析了2001年至2016年期间561例行治疗性角膜移植术治疗难治性微生物性角膜炎的患眼记录。数据包括人口统计学信息、微生物学检查、相关因素、植片大小、术前状态、术后并发症及最终解剖学结果。
外伤是导致治疗性角膜移植术的角膜溃疡最常见原因（267例，47.6%）。病因诊断包括细菌性角膜炎（80眼，14.3%）、真菌性角膜炎（317眼，56.5%）、棘阿米巴角膜炎（3眼，0.5%）及混合细菌/真菌感染（15眼，2.7%）。492眼（87.7%）获得解剖学成功，细菌性角膜炎的预后优于真菌性及混合感染。多因素logistic回归分析显示，糖尿病及术前时间≥30天与解剖学失败显著相关（分别为=0.028和=0.022）。前房积脓、角膜穿孔、手术延迟及/或植片尺寸较大的患者术后并发症（再感染、白内障、青光眼、前房积血或植片排斥）发生率较高（<0.05）。
治疗性角膜移植术是治疗难治性感染性角膜炎的有效方法。及时、恰当的手术可减少并发症并获得更好的疗效。
