结膜瓣遮盖术联合结膜下注射氟康唑治疗重症真菌性角膜溃疡
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摘要
目的:分析结膜瓣遮盖术联合结膜下注射氟康唑治疗重症真菌性角膜溃疡患者的临床疗效。方法:选取2012-01/2015-12收治的重症真菌性角膜溃疡患者50例50眼作为观察对象,随机分为观察组与对照组,每组25例25眼。对照组采取单纯药物治疗,观察组在对照组的基础上加入结膜瓣遮盖术。观察两组患者的临床疗效、矫正视力及不良反应发生率,并随访1a观察两组患者复发情况。结果:治疗1mo后,观察组临床疗效显著高于对照组(P<0.05),观察组矫正视力高于对照组(P<0.05),且在不良反应发生率方面低于对照组,差异有统计学意义(P<0.05);随访1a发现观察组仅有1例患者复发,对照组有8例患者复发,观察组复发率显著低于对照组,差异有统计学意义(P<0.05)。结论:结膜瓣遮盖术联合结膜下注射氟康唑在重症真菌性角膜溃疡患者中具有较好的应用价值,能够有效提高患者的临床疗效,改善患者的视力情况,同时能够有效降低不良反应发生率和复发率。
AIM:To analyze the clinical efficacy of conjunctival flap covering combined with subconjunctival injection of fluconazole on patients with severe fungal corneal ulcer.METHODS:Totally 50 cases with severe fungal corneal ulcer were collected in our hospital from January 2012 to December 2015. The cases were randomly divided into observation group and control group,25 cases in each group. All the cases were monocular sick. The control group took single drug treatment,but the observation group were given with conjunctival flap as an extra. The clinical efficacy,best corrected visual acuity and adverse effects rate were observed. And,the relapse of the two groups was followed for 1 a.RESULTS:After 1 mo of treatment,the clinical curative effect of the observation group was significantly higher than the control group( P< 0. 05),and corrected visual acuity of the observation group was higher than the control group( P<0.05); the adverse reaction rate of the observation group was lower than the control group( P<0.05).After 1 a follow-up,the observation group only had 1 case of recurrence, control group had 8 cases with recurrence,the recurrence rate of the observation group was significantly lower than the control group( P<0.05). CONCLUSION:The conjunctival flap combined with subconjunctival injection of fluconazole has good application value in severe fungal corneal ulcer patients,can effectively improve the clinical curative effect and the visual acuity,and can effectively reduce the incidence of adverse reactions and recurrence rate.
AIM:To analyze the clinical efficacy of conjunctival flap covering combined with subconjunctival injection of fluconazole on patients with severe fungal corneal ulcer.METHODS:Totally 50 cases with severe fungal corneal ulcer were collected in our hospital from January 2012 to December 2015. The cases were randomly divided into observation group and control group,25 cases in each group. All the cases were monocular sick. The control group took single drug treatment,but the observation group were given with conjunctival flap as an extra. The clinical efficacy,best corrected visual acuity and adverse effects rate were observed. And,the relapse of the two groups was followed for 1 a.RESULTS:After 1 mo of treatment,the clinical curative effect of the observation group was significantly higher than the control group( P< 0. 05),and corrected visual acuity of the observation group was higher than the control group( P<0.05); the adverse reaction rate of the observation group was lower than the control group( P<0.05).After 1 a follow-up,the observation group only had 1 case of recurrence, control group had 8 cases with recurrence,the recurrence rate of the observation group was significantly lower than the control group( P<0.05). CONCLUSION:The conjunctival flap combined with subconjunctival injection of fluconazole has good application value in severe fungal corneal ulcer patients,can effectively improve the clinical curative effect and the visual acuity,and can effectively reduce the incidence of adverse reactions and recurrence rate.
引文
1史伟云,李素霞.结膜瓣遮盖术在难治性角膜溃疡治疗中的临床价值.中华眼科杂志2014;43(4):293-296
2 李素霞,史伟云,刘明娜,等.结膜瓣遮盖术治疗难治性角膜溃疡.眼科新进展2017;27(3):204-207
3 谯雁彬,易虹,聂昕,等.结膜瓣遮盖术治疗难治性角膜溃疡的临床研究.重庆医学2015;44(34):4824-4826
4 郭晓飞,肖青,肖凤枝,等.结膜瓣遮盖术治疗难治性角膜溃疡疗效观察.中国实用眼科杂志2016;34(7):735-737
5 陈乐民,李定章.病灶切除联合结膜瓣遮盖术治疗单纯疱疹病毒性深层角膜溃疡疗效观察.中国实用眼科杂志2013;31(7):919-920
6 刘丽丹,余正星.改良结膜瓣遮盖术治疗大泡性角膜病变观察.中国实用眼科杂志2013;31(6):769-771
7 陶丹,杨于力,谢汉平,等.结膜瓣遮盖手术在难治性角膜疾病治疗中的作用评价.第三军医大学学报2016;38(10):1166-1172
8 刘卫卫,翟华蕾,程钧,等.角膜溃疡清创联合结膜瓣遮盖术治疗感染性角膜溃疡的临床疗效.中华眼视光学与视觉科学杂志2016;18(2):115-120
9 邹文进,梁海明,王松,等.结膜瓣遮盖术治疗真菌性角膜溃疡的要点.广东医学2013;34(9):1378-1380
10 张雁冰,成霄黎,董静,等.病灶切除联合结膜瓣遮盖术治疗难治性角膜溃疡.山西医科大学学报2014;41(2):169-171
11 Salvetat ML,Brusini P,Pedrotti E,et al.Higher order aberrations after keratoplasty for keratoconus.Optom Vis Sci 2013;90(3):293-301
12 Patel SV.Graft survival and endothelial outcomes in the new era of endothelial keratoplasty.Exp Eye Res 2012;95(1):40-47
13 Wacker K,Gründemann C,Kern Y,et al.Inhibition of corneal inflammation following keratoplasty by birch leaf extract.Exp Eye Res2012;97(1):24-30
14 Nuzzo V,Plamann K,Savoldelli M,et al.In situ monitoring of secondharmonic generation in human corneas to compensate for femtosecond laser pulse attenuation in keratoplasty.J Biomed Opt 2007;12(6):064032
15 Chih A,Lugo M,Kowing D,et al.Descemet stripping and automated endothelial keratoplasty:an alternative to penetrating keratoplasty.Opto Vis Sci 2008;85(3):152-157
2 李素霞,史伟云,刘明娜,等.结膜瓣遮盖术治疗难治性角膜溃疡.眼科新进展2017;27(3):204-207
3 谯雁彬,易虹,聂昕,等.结膜瓣遮盖术治疗难治性角膜溃疡的临床研究.重庆医学2015;44(34):4824-4826
4 郭晓飞,肖青,肖凤枝,等.结膜瓣遮盖术治疗难治性角膜溃疡疗效观察.中国实用眼科杂志2016;34(7):735-737
5 陈乐民,李定章.病灶切除联合结膜瓣遮盖术治疗单纯疱疹病毒性深层角膜溃疡疗效观察.中国实用眼科杂志2013;31(7):919-920
6 刘丽丹,余正星.改良结膜瓣遮盖术治疗大泡性角膜病变观察.中国实用眼科杂志2013;31(6):769-771
7 陶丹,杨于力,谢汉平,等.结膜瓣遮盖手术在难治性角膜疾病治疗中的作用评价.第三军医大学学报2016;38(10):1166-1172
8 刘卫卫,翟华蕾,程钧,等.角膜溃疡清创联合结膜瓣遮盖术治疗感染性角膜溃疡的临床疗效.中华眼视光学与视觉科学杂志2016;18(2):115-120
9 邹文进,梁海明,王松,等.结膜瓣遮盖术治疗真菌性角膜溃疡的要点.广东医学2013;34(9):1378-1380
10 张雁冰,成霄黎,董静,等.病灶切除联合结膜瓣遮盖术治疗难治性角膜溃疡.山西医科大学学报2014;41(2):169-171
11 Salvetat ML,Brusini P,Pedrotti E,et al.Higher order aberrations after keratoplasty for keratoconus.Optom Vis Sci 2013;90(3):293-301
12 Patel SV.Graft survival and endothelial outcomes in the new era of endothelial keratoplasty.Exp Eye Res 2012;95(1):40-47
13 Wacker K,Gründemann C,Kern Y,et al.Inhibition of corneal inflammation following keratoplasty by birch leaf extract.Exp Eye Res2012;97(1):24-30
14 Nuzzo V,Plamann K,Savoldelli M,et al.In situ monitoring of secondharmonic generation in human corneas to compensate for femtosecond laser pulse attenuation in keratoplasty.J Biomed Opt 2007;12(6):064032
15 Chih A,Lugo M,Kowing D,et al.Descemet stripping and automated endothelial keratoplasty:an alternative to penetrating keratoplasty.Opto Vis Sci 2008;85(3):152-157