大泡深层前板层角膜移植与穿透性角膜移植治疗药物难治性棘阿米巴角膜炎的疗效比较。
Comparison of therapeutic effects between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for medically unresponsive Acanthamoeba keratitis.
机构信息
State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.
State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China.
出版信息
BMC Infect Dis. 2024 Mar 4;24(1):276. doi: 10.1186/s12879-024-09147-w.
PURPOSE
To compare the outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PKP) in the management of medically unresponsive Acanthamoeba keratitis (AK).
METHODS
This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed.
RESULTS
The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group (P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group (P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group (P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups (P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively.
CONCLUSION
Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.
目的
比较大泡深层前板层角膜移植术（BB-DALK）和穿透性角膜移植术（PKP）治疗药物治疗无效棘阿米巴角膜炎（AK）的效果。
方法
本回顾性研究纳入了一家三级眼科治疗中心的 27 只接受 BB-DALK 治疗的眼睛和 24 只接受 PKP 治疗的眼睛。术后 2 个月，根据共聚焦激光扫描显微镜的评估结果，随后在治疗方案中加入糖皮质激素滴眼液。分析临床特征、最佳矫正视力（BCVA）、术后屈光结果、移植物存活率和棘阿米巴复发情况。
结果
纳入研究的 AK 患者处于 2 期或 3 期，PKP 组中 3 期患者的比例更高（P=0.003）。临床表现主要为角膜溃疡和环状浸润，PKP 组中内皮斑、前房积脓、葡萄膜炎和青光眼更为常见（P=0.007）。术后 1 年时，两组间 BCVA 和移植物存活率无统计学差异。然而，术后 3 年时，BB-DALK 组的 BCVA 为 0.71±0.64 logMAR，移植物存活率为 89.5%，内皮细胞密度为 1899±125 个细胞/平方毫米，均显著优于 PKP 组（P=0.010、0.046 和 0.032）。BB-DALK 组有 3 只眼（11.1%）和 PKP 组有 2 只眼（8.3%）发生棘阿米巴复发，但两组间无统计学差异（P=1.000）。PKP 组中有 5 只眼和 6 只眼分别发生免疫排斥反应和眼压升高。
结论
对于对抗阿米巴药物治疗无反应的 AK 患者，建议进行角膜移植。BB-DALK 手术后可维持视力和移植物存活率。棘阿米巴复发与所行手术方式无关，而彻底切除受感染的角膜基质和延迟开具糖皮质激素滴眼液对于预防复发很重要。
Zotero 插件