Luchs J I, Cohen E J, Rapuano C J, Laibson P R
Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA.
Ophthalmology. 1997 May;104(5):816-22. doi: 10.1016/s0161-6420(97)30228-0.
The authors review a large series of patients with bullous keratopathy (BK) to analyze the frequency of ulcerative keratitis, and determine the contributory roles of bullae, bandage soft contact lenses, steroids, and prophylactic antibiotics.
A retrospective review of all cases of pseudophakic or aphakic bullous keratopathy presenting to the cornea service between January 1, 1986 and September 1, 1995 was performed. The influence of time, bullae, bandage contact lenses, steroids, and prophylactic antibiotics was evaluated by actuarial methods and multivariate analysis.
Nine hundred eighteen patients were included in this study, 44 (4.7%) of whom had infectious or inflammatory complications; 813 cases were available for statistical analysis. Steroids (P < 0.0001), bandage soft contact lens use (P = 0.004), and bullae (P = 0.01) had statistically significant independent effect on the risk of developing ulcerative keratitis, and the combination of steroids and bandage lenses yielded the highest risk (P < 0.001). Propylactic antibiotic use paradoxically had a statistically significant association with ulcerative keratitis in these patients (P = 0.01). Increasing BK time was also associated with ulcer development, and the risk remained relatively constant over the 60 months of the study. Streptococcus was the most frequent organism cultured.
Ulcerative keratitis developed in 4.7% of patients with bullous keratopathy. Prolonged BK time alone was a risk factor for infection. The strongest single additional risk factor for ulcer development was steroid use, followed by bandage soft contact lens use, and their simultaneous use had the greatest effect. The presence of bullae was also a risk factor for infection, and prophylactic antibiotic use did not prevent ulcer development.
作者回顾了一系列大疱性角膜病变（BK）患者，以分析溃疡性角膜炎的发生率，并确定水疱、绷带软性接触镜、类固醇和预防性抗生素的作用。
对1986年1月1日至1995年9月1日期间角膜科就诊的所有假晶状体或无晶状体大疱性角膜病变病例进行回顾性研究。通过精算方法和多变量分析评估时间、水疱、绷带接触镜、类固醇和预防性抗生素的影响。
本研究纳入918例患者，其中44例（4.7%）发生感染或炎症并发症；813例可用于统计分析。类固醇（P<0.0001）、使用绷带软性接触镜（P=0.004）和水疱（P=0.01）对发生溃疡性角膜炎的风险有统计学上显著的独立影响，类固醇和绷带镜联合使用风险最高（P<0.001）。在这些患者中，预防性使用抗生素与溃疡性角膜炎有统计学上显著的关联（P=0.01）。BK时间延长也与溃疡形成有关，在研究的60个月中风险相对恒定。培养出的最常见微生物是链球菌。
4.7%的大疱性角膜病变患者发生溃疡性角膜炎。仅BK时间延长是感染的危险因素。溃疡形成的最强单一额外危险因素是使用类固醇，其次是使用绷带软性接触镜，两者同时使用影响最大。水疱的存在也是感染的危险因素，预防性使用抗生素不能预防溃疡形成。
