摘要目的 探讨在足量应用抗生素的前提下局部应用皮质醇激素对于细菌性角膜溃疡(BCU)的疗效及安全性.方法 选择确诊为BCU且符合纳入标准的患者62例,按数字表法随机分为观察(n=33)和对照(n=29).两组予以为期3周的妥布霉素滴眼液治疗,观察组在使用妥布霉素至少48 h以上后辅以0.02％氟未龙滴眼液治疗,持续3周,逐渐减量至停药.观察治疗前后患者的最佳矫正视力(BSCVA)、眼压波动情况、角膜上皮愈合时间、透明度及严重不良事件.结果 治疗3周后,两组平均BSCVA均较基线水平提高,但提高程度的差异无统计学意义；对照组眼压＞21 mm Hg的患者显著增加,与观察组差异有统计学意义(x2=7.272,P＜0.05).随访3个月发现,观察组BSCVA的提高程度显著优于对照组(t=2.388,P＜0.05)；两组眼压基本恢复至基线水平.对照组角膜平均上皮愈合时间为(11.3±4.5)d,明显短于观察组的(14.7±5.2)d(t =2.707,P＜0.05)；但观察组角膜透明度的恢复优于对照组(x2=8.207,P＜0.05).治疗及随访期间,未出现严重不良事件.结论 对BCU患者局部给予皮质醇激素,尽管会延长愈合时间,但可以有效抑制炎症,减少瘢痕形成,控制眼压波动,对远期视力的恢复有积极意义.

abstractsObjective To investigate the clinical efficacy and safety of topical corticosteroids as adjunctive plan in the therapy of bacterial corneal ulcers (BCU).Methods 62 eligible patients with confirmed BCU were screened and divided into 2 groups randomly.Both groups were treated with topical tobramycin for 3 weeks,the observation group received topical tobramycin for at least 48 hours and then treated with 0.02％ fluorometholone for 3 weeks,and decrement setp by step.Best spectacle corrected visual acuity(BSCVA),fluctuation of intraocular pressure (IOP) before and after therapy,time to corneal reepithelialization and clarity,severe adverse event were observed.Results After 3 weeks,BSCVA of both groups increased compared to their baselines,however,no significant difference between the two groups.Patients whose IOP exceed 21mm Hg in the control group was statistically more than that in the observation group(x2 =7.272,P ＜ 0.05).Follow up for 3 months,increasing of BSCVA in the observationgroup was significantly higher than the control group(t =2.388,P ＜ 0.05) ;and lOP of both two groups almost recuperated to baselines.Although the time to corneal reepithelialization of the control group (11.3 ± 4.5) d was shorter than observation group [(14.7 ± 5.2) d] (t =2.707,P ＜ 0.05),the recovery of corneal clarity in observation group was superior to control group (x2 =8.207,P ＜ 0.05).In addition,no severe adverse events were observed during this period.Conclusion Although prolong the healing time of corneal epithelium,corticosteroids as an adjunctive plan in the therapy of BCU may reduce immune-mediated damage,decrease scarring,control IOP fluctuation and improve BSCVA,but with no safety concerns.