眼科 ›› 2025, Vol. 34 ›› Issue (6): 413-417.doi: 10.1328 1/i.cnki.issn.1004-4469.2025.06.001

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重视角膜特殊感染的诊断和治疗

何彦  袁进   

  1. 首都医科大学附属北京同仁医院  北京同仁眼科中心  眼科学与视觉科学北京市重点实验室,北京 100730
  • 收稿日期:2025-11-13 出版日期:2025-11-25 发布日期:2025-11-15
  • 通讯作者: 袁进,Email: yuanjincornea@126.com
  • 基金资助:
    北京同仁医院杰出人才支持项目(2023)

Emphasizing the diagnosis and management of special corneal infections

He Yan, Yuan Jin   

  1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing 100730, China
  • Received:2025-11-13 Online:2025-11-25 Published:2025-11-15
  • Contact: Yuan Jin, Email: yuanjincornea@126.com
  • Supported by:
    Distinguished Talent Support Program of Beijing Tongren Hospital ( 2023 )

摘要: 角膜病是我国常见的致盲性眼病,其中感染性角膜炎是重要致盲因素。随着生活方式改变、新发传染病传播及诊疗模式变迁,特殊角膜感染的误诊风险增加,严重威胁视力预后。对于眼表特殊感染类型,需要重点关注生活方式相关的角膜感染,包括宠物接触导致的微孢子虫角膜结膜炎等。很多新发突发传染病(如猴痘、SARS-CoV-2)及传统疾病(结核、梅毒)均可累及角膜,需警惕其眼部传染性。角膜接触镜(尤其角膜塑形镜)广泛使用,增加了棘阿米巴角膜炎风险,而角膜屈光术后非结核分枝杆菌角膜层间感染亦值得关注。诊断需结合共聚焦显微镜、质谱分析技术及宏基因组测序,后者可全面检测难培养的病原体但需结合临床解读数据结果。治疗上强调多学科协作,创新应用角膜交联术、层间注药及新型递送系统(纳米载体、缓释植入剂),并针对耐药菌开发多粘菌素B衍生物等药物。未来需通过医技联动、多模态实验室体系及人工智能辅助诊断,实现“早诊-快治-防盲”的精准化管理。

关键词: 角膜特殊感染/诊断, 角膜特殊感染/治疗

Abstract:  Corneal diseases are an important leading cause of blindness in China, with infectious keratitis being a major contributor. The evolving lifestyle patterns, emerging infectious diseases, and shifts in clinical practices have heightened the risk of misdiagnosis for atypical corneal infections, posing severe threats to visual prognosis. For ocular surface infections, special attention should be paid to lifestyle-associated cases, including microsporidial keratoconjunctivitis (MKC) linked to pet exposure. Emerging pathogens (e.g., monkeypox virus, SARS-CoV-2) and classical diseases (e.g., tuberculosis, syphilis) can also involve the cornea, necessitating vigilance for ocular transmissibility. The rising use of contact lenses-particularly orthokeratology lenses-has increased the risk of acanthamoeba keratitis, while post-refractive surgery non-tuberculous mycobacterial (NTM) interface infections require close monitoring. Diagnosis should integrate confocal microscopy, mass spectrometry, and metagenomic next-generation sequencing (mNGS). While mNGS enables comprehensive detection of fastidious pathogens, clinical correlation is critical for data interpretation. Therapeutic strategies emphasize multidisciplinary collaboration, adopting innovations such as corneal cross-linking (CXL), intrastromal drug delivery, and advanced systems (e.g., nanocarriers, sustained-release implants). Novel agents like polymyxin B derivatives are under development for drug-resistant strains. Future efforts should focus on clinician-laboratory synergy, multimodal diagnostic systems, and AI-assisted analysis to achieve precision management under the "early diagnosis, rapid treatment, blindness prevention" framework.

Key words: Special corneal infection/diagnosis, Special corneal infection/treatment