目的：观察5g/L左氧氟沙星滴眼液对重症细菌性角膜炎和重症细菌性结膜炎的治疗效果。 方法：收集门诊的重症细菌性角膜炎和重症细菌性结膜炎患者，使用5g/L左氧氟沙星滴眼液频繁滴眼，严重病例联合治疗。记录治疗前后的视力、眼部表现、溃疡深度、组织坏死和前房积脓情况，同时进行病原学检查。 结果：重症细菌性角膜炎患者15例18眼，治疗前的平均视力为0.1±0.13。治疗前的细菌培养阳性率为83%（12例15眼），主要为细菌奴卡杆菌、洛菲不动杆菌、伯克霍尔德菌、龟分枝杆菌、链球菌和葡萄球菌，其中杆菌占73%（11/15）。治疗第3d起患者的症状和体征均明显好转（P<0.01）。治疗后细菌清除率为93%，治疗总有效率为94%，平均治疗时间为21±4.82d，治疗后平均视力为0.5±0.26。重症细菌性结膜炎患者为21例32眼，治疗前的平均视力为0.6±0.31。治疗前的细菌培养阳性率为69%（15例22眼），主要为葡萄球菌、α-溶血性链球菌和假单胞杆菌，其中葡萄球菌占68%（15/22）。治疗第2d起患者的症状和体征均明显好转（P<0.01）。治疗后细菌清除率为91%，治疗总有效率97％，平均治疗时间为15±3.23d，治疗后平均视力为0.7±0.29。两组治疗时间与菌属有相关性（P<0.05）。 结论：重症细菌性角膜炎感染以杆菌为主，其次为葡萄球菌、链球菌，平均治疗时间为3wk。重症细菌性结膜炎感染以葡萄球菌为主，其次是链球菌、假单胞杆菌，病程平均治疗时间为2wk。两组治疗后视力均有提高，未发现视力降低病例。5g/L左氧氟沙星滴眼液可有效治疗重症细菌性角膜炎和结膜炎，严重病例根据病情适当联合用药，未见毒副作用。

AIM: To observe the efficacy of 5g/L levofloxacin eye drops on severe bacterial keratitis and severe bacterial conjunctivitis. METHODS: Subjects diagnosed as severe bacterial keratitis or severe bacterial conjunctivitis in out-patient department were treated with 5g/L levofloxacin eye drops, and the severe patients were treated with combination therapy. Visual acuity, ocular manifestation, ulcer depth, tissue necrosis and hypopyon were recorded before and after treatment, and pathogenic tests were carried out. RESULTS: In 15 cases(18 eyes) with severe bacterial keratitis, the mean pre-treated visual acuity was 0.1±013, and positive ratio of pre-treated germiculture was 83% (12 cases, 15 eyes). The main pathogens included Nocardia, Acinetobacter lwoffii, burkholderia gladioli, Mycobacterium chelonei,Streptococcus,and Staphylococcus, in which bacillus occupied a percentage of 73%(11/15). Both symptoms and signs started to ameliorate in day 3 after treatment (P<0.01). A bacterial elimination rate post-treatment of 93% was observed, with the overall effective rate of 94%. Mean treatment duration was 21±482 days, and the mean visual acuity of post-treatment was 0.5±0.26. In 21 cases(32 eyes) with severe bacterial conjunctivitis including, the mean visual acuity of pre-treatment was 0.6±0.31. The positive germiculture ratio was observed to be 69% (15 patients and 22 eyes) before treatment, with staphylococcus (68%,15/22),α-hemolytic streptococcusand and pseudomonas as the main pathogens. Amelioration was noticed in both symptoms and signs from day 2 after treatment (P<001). The bacterial elimination rate of post-treatment was 91%, overall effective rate is 97%, mean treatment duration was 15±3.23 days, and mean post-treated visual acuity is 0.7±029. Correlation was found in either group between treatment duration and bacterial strains (P<0.05). CONCLUSION: The vital pathogens in severe bacterial keratitis was bacillus, followed by Staphylococcus and Streptococcus. The mean treatment duration was 3 weeks. The vital pathogens in severe bacterial conjunctivitis was Staphylococcus, followed by Streptococcus and Pseudomonas bacillus, and a mean of 2-week treatment was recorded. Visual improvement was found in either group without deterioration in any cases. 5g/L levofloxacin may effectively treat severe bacterial keratitis and severe bacterial conjunctivitis, and in severe cases a proper combination is recommended. No side effect was found in our study.

中国国家自然基金资助项目（No. 81170826）