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穹窿深部异物,因其解剖位置及检查上的忽略,易漏诊.作者1993年内遇3例上穹窿深部异物,报告如下:例1,男,62岁,1993年12月入院.入院前1月,打稻脱粒时被谷粒击伤左眼,当时左眼异物感流泪.次日去当地医院诊为“角膜炎”给氯霉素及地塞米松眼液治疗,未见效来我院求治.门诊按细菌性角膜炎治疗,病情加重而入院治疗.眼科检查:左眼视力指数/30cm.左眼睑中度红肿,混合充血(?),角膜中央6×6mm溃疡,表面干燥呈牙膏样,无光泽,基质层浸润水肿.溃疡中央约1×1mm组织菲薄,前房积脓2mm.瞳孔药物性散大,眼底不可见.翻开上睑,拉钩牵引上提,在穹窿深部见一谷粒嵌置,谷粒已发芽,芽头1.5mm长,予以取出.然后刮除角膜溃疡面坏死组织涂片检查,找到大量霉菌孢子,即给予金褐霉素眼膏每2小时1次涂眼,醋氮酰胺125mg1日2次,口服消炎痛、维生素C.治疗第10天,左眼角膜中央出现小窗孔,予以大剂量金褐霉素眼膏涂眼加压包扎,1月后左眼遗留角膜斑翳及小凹面,视力指数/30cm.
Deep foreign body fornix, due to its anatomical location and inspection on the neglect, easy to miss .In 1993, the case of 3 cases of deep dome foreign body, reported as follows: Case 1, male, 62 years old, admitted in December 1993. January January before admission, When the threshing of rice threshing grain was injured left eye, when the left eye foreign body sensation tears .Treatment to the local hospital the next day as a “keratitis” to chloramphenicol and dexamethasone eye drops treatment, no effective treatment to our hospital. According to bacterial keratitis treatment, the disease aggravated and hospitalized. Eye examination: left eye visual acuity index / 30cm. Left eyelid moderate redness, mixed congestion (?), Central corneal 6 × 6mm ulcer, the surface was dry toothpaste-like, dull , Stromal infiltration of edema. Central ulcer about 1 × 1mm thin tissue, hypoplastic anterior chamber 2mm. Pupil drug bulk, fundus is not visible. Open the upper eyelid, pull the hook traction on the dome to see a grain embedded in the deep , The grain has germinated, bud head 1.5mm long, to be removed.And then scrape the corneal ulcer surface necrosis tissue smear to find a large number of mold spores, that is, give the golden brown eye ointment coated every 2 hours 1 eye, vinegar nitrogen Amide 125mg twice a day, oral indomethacin, vitamin C. The first 10 days of treatment, the left corneal small holes appeared to be Rapamycin dose golden brown eye ointment painted bandaged, left eye cornea and a small concave macula after 1 month, visual acuity index / 30cm.