《眼科学精品教学》仁济医院角膜病课件

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1、角膜病CornealDiseaseAnotomyofCorneaAnteriorsegmentofeye5layersEpitheliumBowman’slayerStromaDescemet’smembraneEndotheliumDiseaseofCornea（角膜病）PhysiologyofCornea5layers,Bowman’slayer,stromallayer,endothelium,cannotregenerateRefractivepower(43D,¾)---refractivesurgerySmooth,Avas

2、cularity,transparency---relativeimmuneprivilegepoornutrition------healingslowlyAbundantnerveending-------severestimulationKeratitis(角膜炎）病因Etiology:External：trauma,infectionEndogenous：vitA,autoimmunediseasesLocalTransmission：infectionofneighbor分类Classification：notunified，

3、oftenbyetiology：bacteria,virus,fungi,acanthamoebaetc.PathogenicProcessofKeratitis角膜炎的病理生理过程浸润期infiltrationstage溃疡形成期Ulcerformationstage溃疡消退期Ulcersubsidiseperiod溃疡愈合期UlcerhealingPathogenicProcessofKeratitis角膜上皮伤无感染，愈合透明感染角膜浸润云翳(nebula)瘢痕斑翳(macula)角膜溃疡白斑(leucoma)台氏膜膨出(desc

4、emetocele)(adhesiveleucoma)眼内炎角膜瘘角膜穿孔粘连性角膜白斑(endophthalmitis)(fistula)眼球萎缩眼内炎继发性青光眼、角膜葡萄肿(cornealstaphyloma)临床表现Clinicalmanifestation症状Symptoms：1)角膜刺激irritative:pain,photophobia,lacrimation,blepharospasm2)视力下降visualacuityfalling体征Signs1）睫状/混合充血ciliarycongestionormixedcon

5、gestion2）角膜浸润、混浊、溃疡cornealinfiltration,opacity,ulcer3）球结膜水肿chemosis4）虹膜反应iridocyclitis：keraticprecipitate,hypopyon5）角膜新生血管形成corneaneovascularizationDiagnosisHistory：外伤、感冒发热、皮质类固醇、全身疾病Symptoms：视力，角膜刺激症Signs：睫状/混合充血、角膜浸润、溃疡、FL(+)，虹膜反应、继发性青光眼等。Lab：微生物培养、药敏试验，尽早FluoresceinSt

6、ain(角膜荧光素染色)角膜上皮的缺损区在采用荧光素染色后，用裂隙灯钴蓝光观察显示出绿色的荧光TreatmentprinciplesEliminatepathogenAnti-infectivetherapyImproveimmunityPromoteHealing，ReducingscarringTreatComplicationsPrevention，ActiveTreatment，RescueVisionTreatmentforActivephase1）anti-infectivetherapy1.化脓性细菌：0.3%tobram

7、ycin,0.3%norfloxacin……2.绿脓杆菌pseudomonas：0.2%polymyxin,0.3%tobramycin,1%gentamycin3.真菌Fungus：0.5%AmphotericinB，0.5%fluconazole……4.Viral(病毒):0.15%acyclovir,ganciclovir,静止期治疗Treatmentforquiescentperiod1）Drugs:①drugs：Dionine②usage：lowconcentration→highconcentrationforhalfaye

8、arormoreTreatmentforquiescentperiod2）Surgery:a.treatingcornealscarbydrugsformorethanoneyearb.thevisuala