目的:描述临床特征,管理,和感染性晶体性角膜病(ICK)的长期结果。
方法:回顾了2011年1月至2022年12月临床诊断和微生物学证实的ICK病例的病历。临床特征包括存在带分支的白色针状突起,仅限于前中基质。角膜移植术是最常见的危险因素,同时还研究了与移植物相关的微生物性角膜炎。人口统计,临床资料,微生物学,治疗,并对结果进行了分析,并与二次移植物浸润(GI)进行了比较。
结果:回顾了24例ICK患者的病历。平均年龄为49.3±20.1岁,男性15人(62.5%)。在18例(75%)中进行了角膜移植术,平均移植物尺寸为10.1±1.5毫米,最后一次移植和出现之间的平均间隔为9.7±6.2(3-90)个月。与GI(n=24)相比,ICK患者(n=18,75%)症状较轻,晚期(7.3±6.5天vs16.3±19.4,p=0.003),使用频繁的局部类固醇(>3次/天,p=0.006),较小的渗透尺寸<4mm(p=0.008),中央(p=0.02),与上皮缺损的相关性较小(p=0.0001),hypopyon(p=0.0002),角膜穿孔(p=0.0006),和手术管理(p=0.03)。在微生物学上,22例(91.6%)ICK培养阳性,14(63.6%)革兰阳性,3(13.6%)革兰氏阴性,2(9%)混合菌,和3种(13.6%)真菌,与GI相当。
结论:ICK通常影响较大移植物大小的角膜移植术后的不良眼表,使用类固醇是最常见的关联,与GI相比,它对医疗管理有反应。
OBJECTIVE: To describe the clinical features, management, and long-term outcome of Infectious crystalline keratopathy (ICK).
METHODS: The medical records of clinically diagnosed and microbiologically proven cases of ICK were reviewed from January 2011 to December 2022. Clinical characteristics include the presence of whitish needle-like projections with branching, limited to anterior-mid stroma. Keratoplasty being the most common risk factor, graft-related microbial
keratitis during the same period was also studied. The demography, clinical profile, microbiology, treatment, and outcome were analyzed, and compared with secondary graft infiltrate(GI).
RESULTS: Medical records of 24 cases with ICK were reviewed. The mean age was 49.3 ± 20.1 years, with 15(62.5%) males. Prior keratoplasty was done in 18 (75%) cases, with a mean graft size of 10.1 ± 1.5 mm, and mean interval between the last graft and presentation was 9.7 ± 6.2 (3-90) months. In comparison to GI (n = 24), ICK patients (n = 18,75%) were less symptomatic, presented late (7.3 ± 6.5 days vs 16.3 ± 19.4, p = 0.003), using frequent topical steroids (> 3 times/day, p = 0.006), smaller infiltrate size < 4 mm (p = 0.008), central (p = 0.02), less associated with epithelial defect (p = 0.0001), hypopyon (p = of 0.0002), corneal perforation (p = 0.0006), and surgical management (p = 0.03). On microbiology, 22 (91.6%) ICK cases were culture positive, 14 (63.6%) gram-positive, 3 (13.6%) gram-negative, 2 (9%) mixed bacteria, and 3 (13.6%) fungus, comparable with GI.
CONCLUSIONS: ICK affects poor ocular surfaces usually following keratoplasty with larger graft size, the use of steroids being the most common association, and it responds to medical management as compared to GI.