两性霉素B角膜基质和前房内注射治疗真菌性角膜脓肿

目的分析两性霉素B角膜基质联合前房注射治疗真菌性角膜脓肿的临床效果。方法回顾性分析我院真菌性角膜脓肿12例12眼,患者均有植物性外伤史,病灶均位于角膜深基质层或内皮面,共焦显微镜检查均见角膜基质内真菌菌丝。常规治疗无效后给予基质联合前房注射0.10g·L-1两性霉素B,其中,基质注射时为在角膜脓肿病灶边缘相对健康角膜处选取4～6个注射点,每点注射约0.02mL,前房注射时为一次性前房注入0.10mL。记录治疗前及治疗后视力、眼压、角膜情况、前房反应以及晶状体状况。术前及术后3个月行角膜内皮检查。结果 6眼1次注射后病灶缩小,未需重复注射病情痊愈;4眼行2～3次注射后病情控制;2眼1次注射后病情仍发展,改行球结膜瓣遮盖术痊愈。术后视力较术前平均提高1.3行。角膜内皮细胞密度治疗前为(2164±156)mm-2,治疗后3个月为(2218±262)mm-2,治疗前后差异无统计学意义(P=0.874)。1眼2次注射后晶状体混浊加重;1眼有一过性眼压升高;5眼治疗后24h前房反应明显,48h后消退。结论两性霉素B角膜基质联合前房注射可以有效治疗真菌性角膜脓肿。

Intrastromal and intracameral amphotericin B injection in treatment of fungal corneal abscess

Objective To evaluate the efficacy of intrastromal and intracameral amphotericin B injection in treatment of fungal corneal abscess.Methods Twelve eyes of 12 patients with fungal corneal abscess that did not respond to initial treatment with topical and systemic antifungal therapy were treated with intrastromal and intracameral injections of amphotericin B(10 g·L-1),4-6 injection spots in healthy cornea around the abscess were chosen when intrastromal injections of amphotericin B,0.02 mL in each spot,0.10 mL amphotericin B was injected once when intracameral injection.All patients had injury histories by vegetable and were diagnosed by confocal microscope.The preoperative and postoperative visual acuity,intraocular pressure,lens and corneal endothelial cell density were recorded.Results Ten cases responded to amphotericin B therapy,the disease focuses in 6 cases with once injection were shortened and cured without repeated injection,4 cases required repeated injections for 2-3 times to control the disease,and 2 cases progressed after injection and healed by conjunctival flap surgery.Visual acuity of all patients improved 1.3 lines postoperatively.The preoperative corneal endothelial cell density was(2164±156)mm-2,and(2218±262)mm-2 at postoperative 3 months,there was no statistical difference(P=0.874).One patient developed cataract after repeated injections.One patient had transitional intraocular pressure increase and 5 patients with significant anterior chamber reaction at postoperative 24 hours,disappeared at 48 hours.Conclusion Intrastromal and intracameral amphotericin B injection can effectively control fungal corneal abscess.