Tian L, Sun X G
Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2020 Apr 11;56(4):294-298. doi: 10.3760/cma.j.cn112142-20200306-00154.
To investigate the clinical characteristics and therapeutic effect of neurotrophic keratitis (NK). A retrospective case series study. A total of 46 patients (48 eyes) with clinically diagnosed NK in Beijing Tongren Hospital from May 2013 to July 2016 were analyzed, including 26 males (26 eyes) and 20 females (22 eyes), aged (51±18) years. The general condition, etiology, clinical features, stage of disease and curative effect of NK patients were summarized. Corneal sensation was measured by Cochet-Bonnet corneal sensor for 25 patients (26 eyes), and the correlation between corneal sensation and clinical staging was analyzed. The χ(2) test was performed on the distribution characteristics of patients with different clinical stages of NK. Correlation analysis of corneal sensation and the disease stage was performed using Spearman correlation analysis. Forty-four cases of monocular disease (96.65%) and 2 cases (4.35%) of bilateral disease were enrolled. Four eyes (8.33%) were from young patients (aged 18-29 years), 23 (47.92%) were from middle-aged patients (aged 30-59 years), and 21 (43.75%) were from elderly patients (aged ≥60 years). The disease was at stage Ⅰ in 8 eyes (16.67%), at stage Ⅱ in 21 eyes (43.75%), and stage Ⅲ in 19 eyes (39.58%). There was no significant difference in clinical staging between the three age groups (χ(2)=2.452, 0.658). The most common cause of NK was virus infection (17 eyes,35.42%), followed by neurosurgical sequelae (11 eyes, 22.92%) and diabetes in 10 eyes(20.83%). Corneal sensation of 26 eyes ranged from 0-3 cm. There was no significant correlation between clinical stage and corneal sensation ((2)=0.284, 0.753). The patients were followed up for an average of 7 months. Thirty-four eyes (70.83%) received conservative treatment, and 8 eyes(16.67%) had surgery. Six patients (6 eyes) were lost for follow-up. NK can occur in all ages, mainly in the elderly. The clinical manifestations are diverse. If time delays in the diagnosis and treatment, it often causes corneal ulcers. There is no significant correlation between corneal sensation and clinical stage. Early diagnosis and targeted treatment are important for protecting patients' visual function..
探讨神经营养性角膜炎(NK)的临床特征及治疗效果。一项回顾性病例系列研究。对2013年5月至2016年7月在北京同仁医院临床诊断为NK的46例患者(48眼)进行分析,其中男性26例(26眼),女性20例(22眼),年龄(51±18)岁。总结NK患者的一般情况、病因、临床特征、疾病分期及疗效。对25例患者(26眼)用Cochet-Bonnet角膜知觉计测量角膜感觉,并分析角膜感觉与临床分期的相关性。对NK不同临床分期患者的分布特征进行χ(2)检验。采用Spearman相关分析对角膜感觉与疾病分期进行相关性分析。纳入单眼患病44例(96.65%),双眼患病2例(4.35%)。4眼(8.33%)来自青年患者(18~29岁),23眼(47.92%)来自中年患者(30~59岁),21眼(43.75%)来自老年患者(≥60岁)。疾病处于Ⅰ期8眼(16.67%),Ⅱ期21眼(43.75%),Ⅲ期19眼(39.58%)。三个年龄组临床分期差异无统计学意义(χ(2)=2.452,P=0.658)。NK最常见的病因是病毒感染(17眼,35.42%),其次是神经外科后遗症(11眼,22.92%),糖尿病10眼(20.83%)。26眼角膜感觉范围为0~3cm。临床分期与角膜感觉无明显相关性(r(2)=0.284,P=0.753)。患者平均随访7个月。34眼(70.83%)接受保守治疗,8眼(16.67%)接受手术治疗。6例患者(6眼)失访。NK可发生于各年龄段,以老年人为主。临床表现多样。若诊治延误,常导致角膜溃疡。角膜感觉与临床分期无明显相关性。早期诊断和针对性治疗对保护患者视功能很重要。