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目的:分析角膜溃疡的病例分布、危险因素、临床特点、微生物检查及预后结果。方法:对2003-07/2006-04就诊于马来西亚大学医学中心的84例(87眼)患者进行研究,其中1例双眼发病,另1例曾因疱疹性角膜炎复发3次就诊。选入标准包括角膜上皮缺损、角膜基质浸润及炎症。结果:患者84例中有男46例,女38例。主要是马来人(52%)。3个主要的危险因素是角膜接触镜的配戴(47%),眼外伤(25%)及眼表疾病(24%)。在老年患者中,糖尿病(8%)及高血压(9%)是重要的系统性疾病。阳性为25%,而微生物培养阳性为73%。在各危险因素组中,绿脓杆菌是最常见的致病菌,在角膜接触镜配戴者中最高。耐庆大霉素革兰染色阴性菌有2例,耐青霉素表皮葡萄球菌有1例。75%的患者溃疡愈合,遗留角膜混浊。2mo后,54%的患眼最佳矫正视力>6/18,14%<3/60。3例患者需要行眼球摘除或剜除术。结论:角膜接触镜配戴和眼外伤是青年人群中主要的可预防性危险因素,相反,眼疾是老年人中不可预防的危险因素。超过60%的培养阳性病例为革兰染色阴性菌。
Objective: To analyze the distribution of corneal ulcer cases, risk factors, clinical features, microbiological examination and prognosis. METHODS: A total of 84 patients (87 eyes) treated at the University of Malaysia Medical Center between July 2003 and April 2006 were studied, including 1 case of binocular disease and 1 case of recurrent herpetic keratitis 3 times. Inclusion criteria include corneal epithelial defects, corneal stromal infiltration and inflammation. Results: There were 46 males and 38 females in 84 cases. Mainly Malays (52%). The three major risk factors were contact lens wear (47%), ocular trauma (25%), and ocular surface disease (24%). Among elderly patients, diabetes (8%) and hypertension (9%) are important systemic diseases. Positive 25%, while the positive microorganism culture was 73%. Pseudomonas aeruginosa was the most common causative agent in each risk factor group and was the highest among contact lens wearers. Gentamicin-resistant Gram-negative bacteria in 2 cases, 1 case of penicillin-resistant Staphylococcus epidermidis. 75% of patients heal ulcers, leaving corneal opacity. After 2 months, 54% of the affected eyes had the best corrected visual acuity> 6/18, 14% <3 / 60.3 patients underwent ocular balloon ablation or mastectomy. CONCLUSIONS: Contact lens wear and ocular trauma are the major preventable risk factors for young people. On the contrary, eye disease is an unacceptable risk factor for the elderly. Over 60% of the culture positive cases are Gram-negative bacteria.