McLeod S D, LaBree L D, Tayyanipour R, Flowers C W, Lee P P, McDonnell P J
Doheny Eye Institute, Los Angeles, USA.
Ophthalmology. 1995 Dec;102(12):1943-8. doi: 10.1016/s0161-6420(95)30771-3.
To identify factors that influence the outcome of patients with severe infectious corneal ulcers.
A retrospective review was performed of the hospital records of all such patients admitted to the Doheny Eye Hospital during a 30 month period. Outcome variables examined were change in visual acuity, duration of hospitalization, hospital charges, and percentage of patients who required penetrating keratoplasty.
Sixty-two ulcers were included. An organism was identified and antibiotic sensitivities established in 52 patients (84%). Inpatient therapy involved a combination of fortified aminoglycoside and cephalosporin antibiotics in 39 patients (63%) and was found to be appropriate on the basis of sensitivity studies in 49 (94%) of 52 patients. Inappropriate initial treatment was related to increased hospital charge (P = 0.024) as well as increased risk of penetrating keratoplasty (P = 0.001).
Appropriate initial therapy is most critical in the course of serious corneal ulcers, and aggressive, broad-spectrum antibiotic coverage is advocated.
确定影响严重感染性角膜溃疡患者预后的因素。
对多希尼眼科医院在30个月期间收治的所有此类患者的医院记录进行回顾性研究。所检查的预后变量包括视力变化、住院时间、住院费用以及需要进行穿透性角膜移植术的患者百分比。
纳入62例溃疡患者。52例患者（84%）鉴定出病原体并确定了抗生素敏感性。39例患者（63%）的住院治疗采用强化氨基糖苷类和头孢菌素类抗生素联合使用，在52例患者中的49例（94%）基于敏感性研究发现这种联合使用是合适的。初始治疗不当与住院费用增加（P = 0.024）以及穿透性角膜移植术风险增加（P = 0.001）相关。
在严重角膜溃疡病程中，恰当的初始治疗最为关键，提倡积极的广谱抗生素覆盖。
