Objective::To evaluate the clinical safety and effectiveness of a dry eye physiotherapy instrument in the treatment of dry eyes.Methods::This was a prospective, multicenter, randomized controlled clinical study. Eligible patients with mild and moderate dry eyes in Henan Institute of Ophthalmology, Suzhou Kowloon Hospital and Affiliated Hospital of Jiangnan University from July to November 2018 were randomly divided into control group and experimental group. The control group were treated with 0.1% sodium hyaluronate eye drops 4 times a day, 1 drop each time for 4 weeks (28±5 days). The experimontd group were treated with dry eye physiotherapy instrument once a day for at least 15 minutes for 4 weeks (28±5 days). The ocular surface of patients were evaluated before treatment and 1 week, 2 weeks and 4 weeks after treatment, and their effectiveness was analyzed; The subjective symptoms of dry eye, tear film rupture time (BUT), Schirmer I test and corneal fluorescein sodium staining were evaluated before and 4 weeks after treatment. The total symptom score was calculated and the effective rate was analyzed. The measurement data were compared by t-test or Wilcoxon rank sum test, and the constituent ratio and efficiency were compared by Chi square test or Fisher exact probability method. Non inferiority verification method was used to compare the difference between the two groups, and the non inferiority limit was set as Δ= 10%, if the lower 95% confidence interval of the difference between the treatment effective rate of the control group and that of the experimental group is greater than-Δ (-10%), it is inferred that the curative effect of the experimental group is not inferior to that of the control group. Results::One hundred and twelve patients were involved, including 41 males and 71 females; and, there was no significant difference in the total score of symptoms and the ocular surface conditions between both eyes of the two groups in the baseline. In the follow-up population, there was no significant difference in ocular surface conditions between the two groups after 1 week, 2 weeks and 4 weeks of treatmen (right: t=0.15, P=0.880; left: t=0.19, P=0.850). After 4 weeks of treatment, there was no significant difference in the total score of symptoms between both eyes of the two groups (right: t=0.20, P=0.840; left: t=0.43, P=0.670). The effective rate of the experimontd group was 72.7%, while that of the control group was 64.8% and there was no significant difference between them ( P>0.05). There were 2 adverse events in the experimental group and 1 adverse event in the control group, the difference was not statistically significant. Conclusion::The effective rate of eye physiotherapy device is 72.7% in treatment of mild or moderate dry eyes, which is not inferior to 0.1% sodium hyaluronate eye drops, and has high safety.

Objective:To study the antimicrobial activity of diacerein on common pathogens of the ocular surface in vitro.Methods:Pathogens were collected from patients with ocular surface infections in Henan Eye Hospital, including Gram-positive cocci and bacilli, Gram-negative bacilli, filamentous fungi, and Candida.The antimicrobial activity of diacerein was determined by the K-B agar diffusion method, and its minimum inhibitory concentration (MIC) was determined by the micro-liquid method.Levofloxacin and voriconazole were used as the control of antibacterial and antifungal drug, respectirely.Results:Diacerein showed antibacterial activity against 42 strains of Gram-positive cocci and 10 strains of Gram-positive bacilli, its inhibition zone diameters for Staphylococcus epidermidis, S.aureus, S.intermedius and Gram-positive Corynebacterium were not significantly different from those of levofloxacin (all at P>0.05). Its MIC range of diacetate against Staphylococcus epidermidis, S. aureus, S. intermedius and other Staphylococci was 1-32 μg/ml, and its respective MIC 90 was 16, 8, 16, and 32 μg/ml.Diacerein had no bacteriostatic effect on 23 strains of Gram-negative bacilli, 10 strains of filamentous fungi and 3 strains of candida. Conclusions:Diacerein has antibacterial effects against Gram-positive Staphylococcus and Corynebacterium isolated from the ocular surface, but shows no antimicrobial activity against Gram-negative bacilli and fungi.Diacerein offers a new drug option and method for the treatment of bacterial keratitis.

Objective: To investigate the in vitro antibacterial sensitivity of levofloxacin, tobramycin, cefazolin sodium, clindamycin and fusidic acid to 67 strains of Staphylococci in ocular surface infection. The purpose of this study is to provide reference for clinical selection of drugs. Methods: Experimental study. Sixth-seven strains of drug-resistant Staphylococci isolated from the Department of Microbiology, Henan Provincial Ophthalmic Hospital during January 2018 and May 2019 were collected. There were 67 strains of Staphylococci including 28 strains of drug-resistant Staphylococcus epidermidi, 17 strains of drug-resistant Staphylococcus aureus, 15 strains of drug-resistant Staphylococcus intermedius and a few other kinds of drug-resistant Staphylococci. The minimum inhibitory concentrations (minimum inhibitory concentration, MIC) of levofloxacin, tobramycin, cefazolin sodium, clindamycin and fusidic acid in 67 strains of drug-resistant Staphylococci were determined by microliquid-based method. The sensitivity was determined according to the American CLSI-M100 standard. The statistical analysis of the data was carried out by using two-dimensional test and Fisher accurate test. Results: Fourteen strains of fusidic acid were sensitive to 17 strains of MRS-Meca-resistant Staphylococcus epidermidis, the difference between fusidic and levofloxacin is statistically significant; 14 strains of cefazolin sodium and 11 strains of fusidic acid were sensitive to 14 strains of β-Lac enzyme-producing Staphylococcus aureus, and there were significant differences between the two drugs and levofloxacin; 6 strains of cefazolin sodium and 5 strains of fusidic acid were sensitive to 10 strains of MRS-Meca-resistant Staphylococcus intermedius, as compared to levofloxacin, there were significant differences between cefazolin sodium and levofloxacin (P=0.011,0.033). Cefazolin sodium was sensitive to 5 strains of MRS-Meca-positive other drug-resistant Staphylococci, which was significantly different from levofloxacin (P=0.048); 54 and 48 strains of cefazolin sodium and fusidic acid were sensitive to 67 strains of drug-resistant Staphylococci, and the sensitive rates were 80.1% and 71.6%, respectively, which were significantly higher than those of levofloxacin, tobramycin and clindamycin. There were significant statistical differences between drug sensitivity (χ²=18.377,9.940；P=0.000,0.003). Conclusions: The sensitivity of cefazolin sodium and fusidic acid to 67 strains of drug-resistant Staphylococci is better than that of levofloxacin, tobramycin and clindamycin, these findings may provide guidance for the clinical treatment of drug-resistant Staphylococci in ocular infection. (Chin J Ophthalmol, 2020, 56: 621-625).

患者男性,23岁,左眼圆锥角膜术后1个月,视物模糊4 d,于2015年3月24日在河南省立眼科医院就诊.患者圆锥角膜术后给予妥布霉素地塞米松滴眼液、加替沙星凝胶、玻璃酸钠滴眼液、牛碱性重组成纤维生长因子凝胶1个月,患者感觉眼涩、不适就诊,除用以上药物,加用维生素A棕榈酸钠滴眼液1周.裂隙灯显微镜下见患者左眼戴角膜接触镜,结膜中度混合充血,角膜植片和植床对合良好,缝线在位、清晰,植片上方可见5 mm×3mm不规则灰白色浸润灶,上皮缺损,下方基质混浊,溃疡及混浊面积约6 mm× 8 mm(图1).角膜共焦显微镜检查见大量真菌菌丝,垂直分枝(图2);0.5％丁卡因局部麻醉后,角膜刮片Giemsa染色显微镜检查见大量蓝色真菌菌丝,长,直角或锐角分枝,并可见棒状分生孢子(图3);未见典型细菌.角膜刮取物和接触镜分别接种于Sabourand培养基,血平皿培养基和增菌肉汤培养基,分别放置26℃～28℃和35℃进行真菌和细菌培养.患者给予0.5％那他霉素滴眼液、0.5％伏立康唑滴眼液和0.5％特比萘芬滴眼液1次/h交替点眼.

OBJECTIVE:To evaluate the efficacy of topical voriconazole in patients with fungal keratitis caused by different fungal species.METHODS:Interventional case series. Eighty-four patients aged 18 years or older from central China with confirmed fungal keratitis who presented at the outpatient department of Henan Eye Institute were enrolled in the study. The patients underwent in vivo confocal scanning laser microscopy examination, coneal scraping and microscopic examination and fungal culture, and then received topical voriconazole, closed curative effects were conducted. The sensitivity of three different diagnostic techniques, spectrum of the fungi, cure rate for fungal corneal infection related to each species were analyzed.RESULTS:In our study, 84 patients were diagnosed with fungal keratitis based on clinical symptoms, and results of at least one of the examinations of in vivo confocal scanning laser microscopy, conventional smear, and corneal scraping culture and the sensitivity were 92.85%(78/84), 85.71%(72/84), 84.52%(71/84)respectively. In viro confocal scanning laser microscopy. Successful management was achieved in 83.33% of the patients. Topical voriconazole treatment failed in 14 patients(16.67%), who required surgical treatment. In 36 patients with Fusarium corneal infections, 26(72.22%)were successfully treated with topical voriconazole; however, in 18 patients with Aspergillus corneal infections and 7 patients with Alternaria corneal infections, 94.44% and 100.00% of them were successfully treated, respectively. In a case-based dynamic tracking study, in vivo confocal microscopy provided real-time dynamic detection of surviving hyphae. The existence of hyphae was(38.35±17.32)days for Fusarium,(25.00±16.11)days for Aspergillus,(21.00±4.36)days for Alternaria, and(41.50±31.68)days for the focus in the deep stroma. The duration of treatment was similar for all four groups.CONCLUSIONS:Topical application of voriconazole is on effective method for the freatment of fungal keratitis Topical voriconazole is highly effective for fungal keratitis caused by Alternaria spp. and Aspergillus, however, for Fusarium, it is relatively low effective. (Chin J Ophthalmol, 2016, 52: 657-662).

OBJECTIVE:To detect the genotypes and in vitro antifungal susceptibility of Fusarium isolated from patients with fungal keratitis in central China.METHODS:Partial translation elongation factor (EF) 1-α of 758 strains of Fusarium isolated from patients with fungal keratitis in Henan Eye Institute during 2002 to 2011 were sequenced. Species and genotypes of Fusarium were identified by conducting BLAST searches of the Fusarium ID database with partial EF1-α sequences as the query. The minimum inhibitory concentrations (MIC) of vorionazole, ketoconazole, terbinafine, natamycin, 5-flucytosine, fluconazol, amphotericin B, nystatin, econazole, clotrimazole, miconazole and itraconazole to 145 isolates of Fusarium were determined by microbroth dilution method according to Clinical Laboratory Standards Institute (CLSI) M38-A program.RESULTS:Among the 758 strains of Fusarium isolates, species of 653 strains were identified. 99.69% of the Fusarium strains were identified by EF1-asequences as Fusarium solani species complex (FSSC), Fusarium oxysporum species complex (FOSC) and Gibberella fujikuroi species complex (GFSC), 0.31% as Fusarium sp. Among the 653 isolates from cornea, FSSC was the predominant Fusarium, 386 isolates (59.11%), with 43 genotypes. The most common seen FSSC genotype was FSSC5-d (132/20. 21%), followed by FSSC3+4-eee (58/8.88%), FSSC3+4-ii (37/5.67%) and FSSC3+4-z (31/4.75%). The second complex was GFSC, 254 isolates (38.90%), with 3 species which were F.proliferatum (124 strains/18.99%), F.verticillioides (112 strains/17.15%) and GFSC (18 strains/2.76%) respectively. The third complex was FOSC, 11 (1.68%) strains, with 6 genotypes. The results of in vitro drug sensitivity test showed that Fusarium strains were sensitive to natamycin, vorionazole and amphotericin B, resistant to 5-fluorocytosine, fluconazole, nystatin, clotrimazole, miconazole. More than 50% of Fusarium strains were sensitive to econazole, ketoconazole, itraconazole and terbinafine. The MIC50 of FSSC to vorionazole, miconazole, terbinafine, Econazole and natamycin was higher than that of F.verticillioides, F.proliferatum and GFSC respectively.CONCLUSIONS:The predominant Fusarium complex of fungal keratitis in central China was FSSC, followed by GFSC. 43 genotypes were included in FSSC in which the most common seen FSSC genotype was FSSC5-d, followed by FSSC3+4-eee, FSSC3+4-ii and FSSC3+4-z. GFSC contained 3 species which were F.proliferatum, F.verticillioides and GFSC respectively. Different genotypes of Fusarium from keratitis had different susceptibility to vorionazole, terbinafine, natamycin and miconazole.

Objective To understand the hospitalization disease spectrum and cost in children and provide the refer-ence for the optimization of the allocation of medical resources. Methods Data of new rural cooperative medical inpa-tients of 0-14 years old in Gongyi city of Henan province from 2011 to 2013 was retrospective analyzed. Results The respiratory disease (55.68%) of 0-14 years old children in Gongyi city was ranked the first,followed by the digestive sys-tem diseases (19.44%);the top 10 single disease were bronchitis (18.98%),upper respiratory tract infection (8.93%),ton-sillitis (8.79%), herpes simplex pharyngeal diverticulum (6.86%), pneumonia (5.42%), bronchial pneumonia (5.05%), asthmatic bronchitis (4.80%),foot and mouth disease (4.56%), jaundice (3.32%),inguinal hernia (2.96%).The majority of patients choosed county hospital treatment;the higher the level of hospital,average daily spend more (P=0.000),the aver-age hospitalization days longer (P=0.001). Conclusion The respiratory disease of 0-14 years old children in Gongyi city is ranked the first,the construction of township hospitals should be strengthened.

It has been claimed for more than a century that atmospheric new particle formation is primarily influenced by the presence of sulfuric acid. However, the activation process of sulfuric acid related clusters into detectable particles is still an unresolved topic. In this study we focus on the PARADE campaign measurements conducted during August/September 2011 at Mt Kleiner Feldberg in central Germany. During this campaign a set of radicals, organic and inorganic compounds and oxidants and aerosol properties were measured or calculated. We compared a range of organic and inorganic nucleation theories, evaluating their ability to simulate measured particle formation rates at 3 nm in diameter (J(3)) for a variety of different conditions. Nucleation mechanisms involving only sulfuric acid tentatively captured the observed noon-time daily maximum in J(3), but displayed an increasing difference to J(3) measurements during the rest of the diurnal cycle. Including large organic radicals, i.e. organic peroxy radicals (RO2) deriving from monoterpenes and their oxidation products, in the nucleation mechanism improved the correlation between observed and simulated J(3). This supports a recently proposed empirical relationship for new particle formation that has been used in global models. However, the best match between theory and measurements for the site of interest was found for an activation process based on large organic peroxy radicals and stabilised Criegee intermediates (sCI). This novel laboratory-derived algorithm simulated the daily pattern and intensity of J(3) observed in the ambient data. In this algorithm organic derived radicals are involved in activation and growth and link the formation rate of smallest aerosol particles with OH during daytime and NO3 during night-time. Because the RO2 lifetime is controlled by HO2 and NO we conclude that peroxy radicals and NO seem to play an important role for ambient radical chemistry not only with respect to oxidation capacity but also for the activation process of new particle formation. This is supposed to have significant impact of atmospheric radical species on aerosol chemistry and should be taken into account when studying the impact of new particles in climate feedback cycles.

Objective To study the relationship between genera and the prognosis in fungal keratitis.Methods Retrospective series case study.A total of 324 cases of fungal keratits from March 2012 to February 2013 in Henan Eye Institute were elected.Slit-lamp examination,corneal smears examination,confocal microscopy,fungal culture and identification were used to diagnose.According to the pathogenic genera,the patients were divided into four groups:fusaria group 172 cases,alternaria group 61 cases,aspergilli group 47 cases and other genera group 44 cases.Follow up the treatment outcomes and record the best corrected visual acuity and the period of treatment of the patients cured by medicines.x2 test,rank sum test and one-way analysis of variance were used to analyze data.Results The surgery rate of fusaria group,aspergilli group,alternaria group and other genera group was 41.3％ (71/172),44.7％ (21/47),6.6％ (4/61) and 11.4％ (5/44) respectively.The differences of the surgery rate among four groups were statistically significant (x2 37.459,P ＜0.001).The surgery rate of fusaria group or aspergilli group was higher than alternaria group or other genera group.The differences of the prognosis among four groups were statistically significant (Hc 38.879,P ＜0.001).The prognosis of fusaria group and aspergilli group was worse than alternaria group and other genera group.Among the patients cured by medicines,the average period of usingdrugs of the patients infected by fusaria,alternaria,aspergilli or other genera was (88±44),(57±30),(68±33) and (59±37)d respectively.The differences of the average period of using drugs among four groups were statistically significant (F 10.221,P ＜0.001).The period of using drugs of the fusaria group was longer than the alternaria group,the aspergilli group and the other genera group.The average recovered visual acuity of the eyes infected by fusaria,aspergilli,alternaria or other genera was 0.65±0.26,0.64±0.26,0.82±0.21 and 0.75±0.27 respectively.The differences of the recovered visual acuity among four groups were statistically significant (F 6.210,P ＜0.001).The recovered visual acuity of the alternaria group was better than the fusaria group and the aspergilli group.Conclusions The prognosis of fungal keratitis caused by fusaria or aspergilli is worse than alternaria or other genera,and has the characteristics of worse effects of drug treatment,lengthier drug treatment,worse recovered visual acuity and higher rate of surgery.

Objective To investigate the microbial profiles and clinical features on suture erosions and abscesses after therapeutic corneal transplantation. Methods Of 11 consecutive cases of suture erosions and abscesses after therapeutic corneal transplantation were enrolled within 2 years, including 9 cases fugal keratitis and 2 cases recurrent stromal keratitis with perforation. In each case, both bacterial and fungal cultures were taken from eroded sutures and conjunctival sac. Clinical features on suture erosions and abscesses were recorded, including therapeutic regimen and results. Results All episodes of suture erosions and abscesses occurred within 3 months postoperatively, on average 31.8 days. Of the 11 cases, 3 had positive cultures and,suture and cul-de-sac cultured micro-organisms matched in 2 cases. Suture erosion and abscess were primarily located superior and palpebral fissure area, with 4 (36.3%) superiorly and 3 (27.3%) palpebrally. Graft rejection in 2 cases was determined clinically. Removal of involved sutures and sensitive topical antibiotic were employed and all cases healed within 1 week. Conclusions Suture erosions and abscesses after therapeutic corneal transplantation occur on early stage, associating with eyelid rubbing, loosening of sutures, contamination and inflammation of bed. Most cases are sterile, gram-positive bacteria are most common cultured organisms in infected ones. Therapeutic strategies are removal of involved sutures and sensitive topical antibiotic. Diagnosis and treatment in a timely fashion contribute to good prognosis.

诺卡菌角膜炎临床非常罕见,仅占细菌性角膜炎的0.3％～0.8％[1].以往报道诺卡菌角膜炎继发于准分子激光角膜原位磨镶术(laser in situ keratomilusis,LASIK)术后[2]、角膜移植术后[3]及戴角膜接触镜后[1,4].该病属于罕见病,易误诊、误治,值得临床医师高度警惕.目前,国内尚无活体状态下观察诺卡菌的报道,我们收集经角膜激光共焦显微镜观察并诊治的5例患者,报道如下。

Aim:To explore an easy and quick method for the diagnosis of fungal keratitis.Methods:A total of 58 cases of fungal keratitis were diagnosed by positive fungal culture.Corneal scrapings from these patients were used to prepare smear.The same smear was firstly stained by KOH wet mounts then by Calcofluor White(CFW).The results were compared.Results:The positive rates of KOH microscopic examination and CFW staining fluorescence were 81.0%(47/58) and 96.6%(56/58),respectively,and the difference was significant(χ2=7.11,P0.001).Conclusion:Characterized by quick,simple,exact,and high positive rate,CFW staining fluorescence is better than KOH microscopic examination in diagnosis of fungal keratitis.

Objective To discuss the effect of rigid gas-permeable contact lenses(RGPCL)on cells on the conjunctival surface.Methods Sixty eyes of 30 patients with ametropia wearing RGPCL were collected,which chosen the proper lens based on the refraction,corneal curvature.The conjunctival impression cytology was performed before wearing RGPCL and at 6 months and 1 year after wearing RGPCL.The conjunctival epithelial cells and goblet cells were examined under the light microscope,the cells were counted under 100 amplify times and 7.20 mm×5.35 mm area,and the grading was carried.Results Before wearing RGPCL and 6 months,1 year after wearing RGPCL,the number of conjunctival epithelial cells in lower eyelid were(318.5±155.4)cases,(305.6± 79.9)cases and(272.9±86.4)cases,respectively,goblet cells in lower eyelid were(13.6±6.8)cases,(13.2±6.6)cases,and(12.3±5.9)cases,respectively,the bulbar conjunctiva epithelial cells were(244.1±110.9)cases,(226.7±86.3)cases and(228.5±155.4)cases,respectively,the bulbar conjunctiva goblet cells were(15.2±5.7)cases,(15.1±5.5)cases,(14.3±6.6)cases,respectively.For the number of conjunctival epithelial cells in lower eyelid,goblet cells in lower eyelid,the bulbar conjunctiva epithelial cells,the bulbar conjunctiva goblet cells and the grading by conjunctival impression cytology after wearing RGPCL,there was no statistical difference compared with that before wearing RGPCL(P>0.05).Conclusion The effect of wearing RGPCL on conjunctiva in lower eyelid and bulbar conjunctiva is minor.

Objective To investigate the process of cornea infection by main fungi in china under confocal microscopy in vivo and to provide valuable information for the study of fungal kertitis.Methods Two kinds of standard strain were chosen for innoculation,Fusarium Solani(FS) and Aspergillus Fumigatus(AF).Two sorts of mouse models of fungal keratitis were established by corneal scarification with above-mentioned strain respectively.At different points in the development of fungal keratitis,the infected corneas were observed under confocal microscopy.Results Confocal laser microscope image showed that fusarium solani appeared as the short line or worm-like structure in the early stage of infection and later became long and strong linear structure with few branches.The shape and structure of the cornea were obviously damaged in involved area.In the early stage of infection,Aspergillus flavus appeared as short,small curved worm-like structure and later became more curved dendritic or clustered structure with more branches.The shape and structure of the cornea disappeared in involved area.Conclusion In vivo confocal microscopy is potentially useful for monitoring of disease progression and excluding suspected cases of fungal keratitis.The hypha appeared different configuration in different kinds of fungal keratitis and at during different stage of the disease under confocal microscopy.

Objective To evaluate the species of bacteria on the conjunctiva of the young with ametropia.Methods A total of the young(13.01±5.01)years old in the optic center of the Ophthalmol Institute of Henan Province were examined.The professional person embrocated the inferia palpebral conjunctiva with sterile swab.Then the swab was put in glucose soup enriched medium for about 18 to 24 hours.After some soup was smeared on blood plate for 24 hours,the bacteria was seperated and identified.Results 215 with ametropia were examined.The positive rate of the cultivation was 77.2%(166/215).The most dominant was Staphylococcus epidemids(121 strains,72.9%).Conclusion Bacteria could be found in most people's conjunctiva with ametropia and the most dominant bacteria was Staphylococcus epidemids.

Objective To evaluate the species of bacteria on the conjunctiva of the young with ametropia.Methods A total of the young(13.01±5.01)years old in the optic center of the Ophthalmol Institute of Henan Province were examined.The professional person embrocated the inferia palpebral conjunctiva with sterile swab.Then the swab was put in glucose soup enriched medium for about 18 to 24 hours.After some soup was smeared on blood plate for 24 hours,the bacteria was seperated and identified.Results 215 with ametropia were examined.The positive rate of the cultivation was 77.2%(166/215).The most dominant was Staphylococcus epidemids(121 strains,72.9%).Conclusion Bacteria could be found in most people's conjunctiva with ametropia and the most dominant bacteria was Staphylococcus epidemids.

患者,女,57岁.20 d前修剪苹果树时右眼被树枝扎伤后出现疼痛、畏光、流泪、视力减退,在当地静脉滴注青霉素钾800万U,每日1次,同时用0.3%氧氟沙星滴眼液频繁点眼2周,效果不佳,于2009年3月10日到河南省眼科研究所就诊,视力为右眼指数/1 m,左眼1.0.裂隙灯显微镜检查见结膜中度混合性充血,瞳孔中央稍偏颞下方角膜可见4 mm×5 mm密度不均的白色溃疡,边缘模糊(图1).角膜刮片10%KOH湿片及吉姆萨染色可见大量真菌菌丝,直径4.5～10 μm,锐角或直角分支外尚有较多厚垣孢子,直径11～20 μm,HRT3显示自角膜表面至角膜内57 μm,粗细不均且呈锐角或直角分支的线型高反光真菌菌丝,在病灶中心及边缘浸润生长(图2)。

蜡样芽孢杆菌是导致食物中毒的常见病原菌,其所引起的角膜炎较罕见.2006年7月河南省眼科研究所诊治1例因摘取角膜接触镜时指甲损伤角膜引起的蜡样芽孢杆菌性角膜炎患者.

感染性角膜炎是准分子激光原位角膜磨镶术(laser in situ keratomileusis, LASIK)术后最严重的并发症之一,常严重危及视力甚至导致眼球丧失.文献报道其发生率1/1000～1/5000[1],但实际发生率可能较此高,因为有些感染的病例并未报道.文献报道的致病原因有金黄色葡萄球菌、链球菌、凝同酶阴性葡萄球菌、肺炎双球菌、分枝杆菌、真菌、放线菌、棘阿米巴及病毒等.笔者遇到一例混合感染的患者,现报告如下,以引起同道关注.

分析62例(62眼)外伤感染性角膜炎的共焦显微镜镜下显微特征及临床特点.24例细菌性角膜炎中,16例角膜上皮层或浅基质层伴有1～2 μm高反光点.38例真菌性角膜炎中,14例角膜上皮层及浅基质层检查到长50～200 μm,直径2～5 μm的树枝状真菌菌丝;11例(28.9%)显示浅、中基质层的杂乱分布的直、长线状菌丝,长150～300 μm,直径3～7 μm;3例在浸润的周边部可观察到直径12～15 um的高亮度圆形、椭圆形实心球体真菌孢子.27例(71.1%)真菌性角膜炎有明确的植物外伤史,9例(37.5%)细菌性角膜炎有角膜接触镜配戴史.裂隙灯显微镜检查:32例(84.2%)真菌性角膜炎可见菌丝苔被,28例(74.4%)可见不规则或羽毛状边缘.真菌性角膜炎菌种鉴定为镰孢菌属18例(47.5%).共焦显微镜可显示典型的真菌菌丝及真菌孢子,在真菌性和细菌性角膜炎的鉴别诊断中具有重要价值.