McDonnell P J
Department of Ophthalmology, Doheny Eye Institute, Los Angeles, Calif, USA.
Arch Ophthalmol. 1996 Jan;114(1):84-7. doi: 10.1001/archopht.1996.01100130080013.
In the United States, about 30,000 bacterial corneal ulcers are treated annually. Compared with 100, or even 20, years ago ophthalmologists today have available to them many diagnostic tools (including special media and bacterial identification techniques), and in impressive assortment of antibiotics. Many reviews and book chapters describe the uses of microbiologic studies--from Gram and Giemsa staining to media inoculation to immunofluorescence and even molecular genetics--to identify causative organisms. This literature also describes the formulas for preparation of highly concentrated, "fortified" antibiotics for initial treatment of bacterial keratitis, until culture and sensitivity results are available to guide modifications in therapy. It would seem, therefore, that "experts" in the field of corneal and external diseases have reached consensus on an appropriate initial microbiologic evaluation and treatment of suspected microbial keratitis, and the large body of literature on this topic might be considered to represent practice guidelines. It comes as a surprise to many that these published "guidelines" apparently are routinely ignored in current clinical practice.
在美国，每年约有3万例细菌性角膜溃疡得到治疗。与100年前甚至20年前相比，如今的眼科医生拥有许多诊断工具（包括特殊培养基和细菌鉴定技术），以及种类繁多的抗生素。许多综述和书籍章节都描述了微生物学研究的用途——从革兰氏染色和吉姆萨染色到培养基接种、免疫荧光甚至分子遗传学——以鉴定病原体。这些文献还描述了用于细菌性角膜炎初始治疗的高浓度“强化”抗生素的配方，直到获得培养和药敏结果以指导调整治疗方案。因此，角膜和外眼疾病领域的“专家”似乎已就疑似微生物性角膜炎的适当初始微生物学评估和治疗达成共识，关于这一主题的大量文献可能被视为代表了实践指南。令许多人惊讶的是，这些已发表的“指南”在当前临床实践中显然经常被忽视。
