在流行性角结膜炎的伪膜形成阶段是否使用激素的探讨

Whether to Use Corticosteroids in the Pseudomembrane Formation Stage of Epidemic Keratoconjunctivitis

摘要: 目的：探讨在流行性角结膜炎的伪膜阶段使用激素是否能够缩短病程、减少或减轻角膜上皮下浸润的发生。方法：回顾性分析自2012年9月至2020年8月期间在中山大学附属第五医院眼科就诊的流行性角结膜炎患者共105例发病时间<72小时并出现伪膜形成的第一只眼(105只眼)。其中56例为局部糖皮质激素治疗组，49例为非激素治疗组。记录结膜炎痊愈时间、角膜上皮脱落发生率、角膜上皮下浸润发生情况，对数据进行统计分析。结果：局部糖皮质激素治疗组较非激素治疗组的结膜炎痊愈时间长、角膜上皮脱落发生率高，差异有统计学意义(P < 0.05)；局部糖皮质激素治疗组与非激素治疗组的角膜上皮下浸润发生率差异无统计学意义(P > 0.05)。局部糖皮质激素治疗组较非激素治疗组的角膜上皮下浸润程度轻，差异有统计学意义(P < 0.05)；局部糖皮质激素治疗组与非激素治疗组均无不良事件发生，差异无统计学意义(P > 0.05)。结论：在流行性角结膜炎的伪膜形成阶段使用局部糖皮质激素能够减轻角膜上皮下浸润程度，但是会延长结膜炎痊愈时间、增加角膜上皮脱落发生率，并且不能减少角膜上皮下浸润发生率。

Abstract: Objective: To investigate whether the use of corticosteroids in the pseudomembranous stage of epidemic keratoconjunctivitis can shorten the course of disease and reduce or mitigate the occurrence of subepithelial keratitis. Methods The first eyes (105 eyes) of 105 patients with epidemic keratoconjunctivitis onset time <72 hours and had pseudomembrane formation were analyzed retrospectively from September 2012 to August 2020. Among them, 56 cases were treated with topical corticosteroids and 49 cases were not treated with corticosteroids. The healing time of conjunctivitis, the incidence of corneal epithelial exfoliation and the incidence of subepithelial keratitis were recorded, and the data were statistically analyzed. Results: The healing time of conjunctivitis in the topical corticosteroids treatment group were longer than those in the noncorticosteroids treatment group (P < 0.05); the incidence of corneal epithelial exfoliation in the topical corticosteroids treatment group were higher than those in the noncorticosteroids treatment group (P < 0.05); there was no significant difference in the incidence of subepithelial keratitis between the two groups (P > 0.05). The degree of subepithelial keratitis in the topical corticosteroids treatment group was less than that in the noncorticosteroids treatment group (P < 0.05); there were no adverse events between the two groups (P > 0.05). Conclusion: In the pseudomembrane formation stage of epidemic keratoconjunctivitis, the use of topical corticosteroids can reduce the degree of subepithelial keratitis, but it may prolong the healing time of conjunctivitis, increase the incidence of corneal epithelial exfoliation, and can not reduce the incidence of subepithelial keratitis.