第四、五次课 角膜病 华中科技大学同济医学院 第一临床学院眼科
角膜病 Corneal disorders — Corneal diseases Where is the cornea? Importance refractive tissue transparent tissue blindness!! avascular tissue
Cornea The epithelium wing cells\the surface cells \basal membrane Bowman’s membrane The stroma Descemet’s membrane The endothelium
internal systemic allergy? 角膜炎 Keratitis Etiologies external pathogenic trauma internal systemic allergy? local
Type of Keratitis Infective Allergic Keratitis following skin and mucous membrane diseases Keratitis as a manifestation of systemic diseases Exposure,desiccation and neurotrophic Of obscure aetiology
Clinical manifetation Symptoms photophobia no special eye pain
Signs congestion : ciliary edema opacities vision↓ neovascularization secondary iritis
Pathology normal infiltration corneal nebula, macula facet leucoma ulcer descemetocele fistula perforation adherent leucoma staphyloma endophthalmitis panophthalmitis blindness
examination:stain fluorescin Diagnosis history examination:stain fluorescin lab test
Treatment 1. Active stage 2.Sequelae eyedrops ointments local sb.con.injection antibiotics oral drugs systemic mydriasis iv steroid glucocorticoids physical or chemical therapy operation drugs dionine operation keratotransplant
Bacterial keratitis Cause : injuries + infection 葡萄球菌 金葡菌 细球菌 肺炎双球菌 葡萄球菌 金葡菌 细球菌 肺炎双球菌 链球菌 绿色链球菌 假单胞菌 绿脓杆菌 Symptoms : no spccial . vision (often) Sign : edema . injection . infiltration . ulcer Treatment : 喹喏酮类,氨基糖苷类
匐行性角膜溃疡 (serpiginous ulcer)
匐行性角膜溃疡 (serpiginous ulcer)
绿脓杆菌角膜溃疡 (pseudomonas ulcer)
绿脓杆菌角膜溃疡 (pseudomonas ulcer)
fungal keratitis Cause : injuries + infection (植物或农作物) 镰刀菌属 念珠菌属 曲霉菌属 青霉菌属 Symptoms : 轻,发展缓慢
Sign :(见后图) Treatment : 多烯类(二性霉素,匹马霉素) 咪唑类(咪康唑) 嘧啶类(氟胞嘧啶)
fungal keratitis
Fungal keratitis
Herpes simplex keratitis Cause : HSV-1 primary infection→trigeminal nerve→ secondary infection Manifestation :
Treament : antiviratics 无环鸟苷 (acyclovir) 环胞苷 (cyclocytidine) 三氟胸腺嘧啶核苷 (trifloridine) 碘苷 (idoxuridine) steroids——interstitial keratitis 特殊的诱因,反复发作的历史,典型的病灶, 角膜感觉减退,激素诱发和加重
Acanthamoeba keratitis cause:acanthamoeba manifestation:severe pain radial keratitis pseudo-dendratic k
Mooren`s uleer Cause:allergy Sign:
Treatment local steroids amniotic transplant stem cells transplant amniotic+stem cells
细菌性、真菌性、病毒性角膜炎鉴别表 细菌性 真菌性 病毒性 诱因 外伤或挑异物 植物或农作物外伤 抵抗力低下 病史 起病急,发展快,症状重 起病缓,进展慢,症状轻 反复发作,症状多异 分泌物 多, 脓性 少, 泡沫状 少,水样 病变特点 溃疡凹陷,基底坏死物多 周围致密的浸润 少有前房积脓,液平 病灶隆起,干燥 伪足,卫星状 早期前房积脓,液不平 周围浅沟,免疫环 树枝状 盘状 坏死性 地图状 治疗反应 抗细菌有效 抗真菌有效,其它无效 抗病毒有效
Keratoplasty(KP) treatmeat refraction cosmetology lamellar KP lamellar KP penetrating KP
Cornea allograft artificial cornea tissue engineering clonal cornea