关键词: 单纯疱疹病毒性角膜炎, 回顾性研究, 更昔洛韦, 综合治疗

Abstract:  Objective To investigate the causes of the delaying treatment of severe herpes simplex keratitis (HSK) and to evaluate the clinical effects of comprehensive treatment for HSK. Design Retrospective case series. Participants 102 eyes of 100 patients with severe HSK attended to Peking Union Medical College Hospital from Sep. 2008 to Nov. 2010. Methods The treatment histories of 52 patients (53 eyes) with complete records were retrospectively analysed. For all of the participants, ganciclovir were administered 0.5~1.0 g, 3 times per day orally and 4 times per day locally combined with 0.1% fluorometholone eye drops 3 times per day or 20~30 g prednisolone once per day orally; and tropicamide 1~3 times per day according to the condition. Preventive antibiotics were administered in cases with corneal ulcer and incomplete epithelium, while eye protectants in all cases. Visual acuities and signs were evaluated before and after the therapy at 1st，2nd, and 4th week. Curative effects were analyzed. Main Outcome Measures Causes of the delaying treatment; visual acuity, ciliary congestion, corneal infiltration, corneal opacity, corneal edema, folding of the descemet membrane and keratic precipitates; effective and curative rate. Results 12 (23.08%) of severe HSK cases were misdiagnosed as iritis administered with steroid without antiviral drugs, in which 2 patients were misdiagnosed as iritis combined with band degeneration of cornea and 1 patient was misdiagnosed as iridocorneal endothelial syndrome. Keratitis type of  32 (61.54%) cases was not clarified, 24 (75%) of which were administered with antibiotics without antiviral drugs. 24 (66.67%) patients who suffered iritis or trabecular meshwork inflammation were not administered with steroid or ciliary body relaxant. 1 patients suffered secondary ocular hypertension caused by trabecular meshwork inflammation was administered with pilocarpine every hour. For the effects of the comprehensive treatment, comparing with the mean visual acuity before the treatment (0.29±0.40), the mean visual acuity at 1st, 2nd, and 4th week (0.34±0.41, 0.42±0.42, and 0.56±0.45, respectively) after the treatment was improved significantly (t=6.153, 7.275, 9.220, respectively, all P=0.000). The conditions of ciliary congestion, corneal infiltration, corneal opacity, corneal edema, folding of the descemet membrane and keratic precipitates improved significantly at 1st，2nd, and 4th week (F=231.543，136.700，106.031，58.323，19.183，60.590, respectively； all P=0.000). During the follow-up observation for 1 year, 4 cases (3.92%) developed recurrence and 3 cases (2.94%) got their cornea become thin with the condition under control. No other adverse conditions was observed. Conclusion It is the important guarantee to cure severe HSK that attention should be paid to original diagnosis and comprehensive treatment.

Key words: herpes simplex keratitis, retrospective study, ganciclovir, comprehensive treatment