| Infectious keratopathy is one of the major blinding diseases in China and other developing countries,accounting for the first place in corneal blindness.Due to differences in natural environment,climatic geography,and socioeconomic status,the epidemiological characteristics of infectious keratopathy vary from country to country,from group to population,and even from time to time in the same region.There is currently no epidemiological survey of population-based infectious keratopathy in China,lacking baseline data and population distribution characteristics.This topic intends to analyze the clinical data of patients with infectious keratopathy admitted to Qilu hospital of Shandong University in recent years.The content includes two parts.The first part:202 cases in 2014-2018 retrospective analysis of infectious keratopathy;Part II:Report of 6 cases of typical complex,refractory infectious keratopathy.Objective:Through detailed retrospective analysis of 202 cases of infectious keratopathy hospitalized in our hospital from 2014 to 2018,the clinical analysis of various types of corneal infectivity Experience in the diagnosis and treatment of diseases,improve the level of diagnosis and treatment.Method:The clinical data of 202 patients with infectious keratitis who were hospitalized in the Department of Ophthalmology of Qilu Hospital of Shandong University and met the clinical diagnostic criteria were collected.The epidemiological characteristics,risk factors,clinical signs,pathogen examination,diagnosis and treatment were retrospectively analyzed.Results:Of the 202 patients with infectious keratopathy,121(59.9%)were male and 81(40.1%)were female,the sex ratio was 1.49:1,the age of illness was concentrated between 41 and 70 years old,and the occupation was farmers(52.0%).Mainly.In the etiology classification,viral keratitis accounted for the first 73 cases(36.1%),followed by fungal keratitis in 53 cases(26.2%),bacterial keratitis in 48 cases(23.8%),mixed infection(including Acanthamoeba)18 cases(8.9%),10 cases(5.0%)with unknown causes.The prevalence of bacterial keratitis is decreasing year by year,and the prevalence of fungal keratitis is on the rise.There is a statistically significant difference in the probability of fungal keratitis between farmers and other occupational groups.From September to November,the total prevalence of infectious keratopathy was higher.Infectious keratitis patients in winter were mostly infected with viruses,and most of them were fungal infections in autumn.Except for Henan Province,Hebei and Anhui provinces,the remaining 188 patients were from all regions of Shandong Province,with Dezhou(21.3%),Heze(14.9%)and Jinan(13.9%)accounting for a larger proportion.The most common factors for pathogenesis contain corneal trauma(27.7%)and secondary upper respiratory infection(13.4%)and poor glycemic control(12.9%).Viral keratitis was the first place in ocular diseases(18.3%).3 cases of Pseudomonas aeruginosa,2 cases of Streptococcus pneumoniae and Staphylococcus epidermidis,and 1 case of Streptococcus viridans were cultured in bacterial keratitis or bacterial infection patients.The positive rate of Scraper culture was 17.4%.In the pathogen examination method of fungal corneal infection,the detection rate of confocal microscopy was higher than that of corneal scraping microscopy and fungal culture,and the difference was statistically significant.Among the 22 cases of fungal culture,Fusarium accounted for 17 cases(77.3%),followed by Aspergillus 4 cases(18.2%).Infectious keratopathy ulcers or infiltrating lesions were mostly concentrated in the center of the cornea(82.2%),Statistical analysis was performed on the location of keratitis lesions of bacteria,fungi and viruses.There was no significant difference between the three.37 eyes(18.3%)had anterior empyema,and 16 eyes(7.9%)had corneal perforation.Statistical analysis showed that there was no significant difference in the probability of corneal perforation between patients with anterior chamber empyema and those without empyema(P>0.05).There was no significant difference in the probability of corneal perforation between the three types of keratitis infections of bacteria,fungi and viruses(P>0.05).).Patients with viral keratitis in the past had a higher probability of corneal perforation than patients without this history(P<0.05).There was no significant difference in the risk of bacterial,fungal,and viral infections between diabetic and non-diabetic patients(P>0.05).161 patients(79.7%)received simple drug therapy,and 61 patients(30.3%)underwent different degrees of non-pharmacological intervention,including penetrating keratoplasty,iodine fistula burning,corneal stroma injection and conjunctival or amniotic membrane coverage,The treatment effective rate was 91%.Most of the hospital stays were concentrated in 1-2w(42.6%).Conclusion:1.Infectious keratopathy patients are mostly male farmers,viral infectionsrank first,followed by fungal and bacterial infections.The prevalence of bacterial keratitis is decreasing year by year,and the prevalence of fungal keratitis is increasing year by year.Farmers have a higher probability of having fungal keratitis than other occupational groups.Infectious keratitis patients in winter are mostly infected with viruses,while in autumn,they are mostly fungi.The main risk factor for the disease is still corneal trauma.2.In the pathogenic examination of fungal corneal infection,the positive rate of corneal confocal microscopy is higher than that of corneal scraping microscopy and fungal culture.The resulting fungus is most commonly found in Fusarium,China's infectious keratitis fungal genus has not changed.3.Infectious keratopathy ulcers or infiltrates are mostly located in the center of the cornea.The probability of corneal perforation in patients with anterior chamber empyema is not statistically different from that in patients without empyema.Patients with a history of viral keratitis have higher Perforation rate than patients without this history.4.Poor blood glucose control in diabetic patients accounted for the third risk factor for infectious keratopathy.19.2%of patients had elevated blood glucose due to the first diagnosis of ophthalmology.There was no significant difference in the risk of bacterial,fungal and viral infections between diabetic and non-diabetic patients. |
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