伏立康唑联合那他霉素治疗真菌性角膜溃疡

目的探讨伏立康唑全身用药联合那他霉素眼部用药治疗眼外伤后真菌性角膜溃疡的临床疗效。方法22例（22眼）真菌性角膜溃疡根据病情轻重予以口服伏立康唑首日800mg／d（400mg，2次／d），次日400mg／d（200mg，2次／d），疗程14—21d。联合那他霉素滴眼液滴眼，最初用药时1次／h滴眼，14d后如临床症状明显改善，可减少至6～8次／d，持续滴眼3～4周，炎症消退后逐渐减少用药频率，直至共焦显微镜提示未查及菌丝后再维持3周；角膜局部清创及碘酊烧灼，观察联合用药效果。结果22例中17例达到临床治愈（有效率为77．27％），5例无效，其中3例行眼内容摘除术，2例行角膜移植手术治疗。所有患者均未出现严重药物不良反应。结论伏立康唑全身用药联合那他霉素眼部用药治疗真菌性角膜溃疡安全、有效，为难治性真菌性角膜溃疡提供了新的选择。

Clinical efficacy of Voriconazole with Natamycin for the treatment of fungal corneal ulcer

Objective To investigate the clinical efficacy of Voriconazole combined with Natamycin for the treatment of fungal corneal ulcer after eye injury. Methods 22 eyes of 22 patients with fungal corneal ulcer were treated with Voriconazole systematically, first day 800 mg/d （400 rag, bid） , then 400 mg/d （200 rag, bid）, for 14-21 days according to the severity, combined with Natamycin eye drops application topically. The initial administration of Natamycin were once an hour. If the clinical symptoms were significantly improved after 14 days, it were reduced to 6 - 8 times/d for 3-4 weeks. If the inflammation subsided, the frequency of administration might be reduced gradually, and maintained for 3 weeks after the mycelium were not found by confocal microscopy. Corneal debridement and iodine tincture cautery were performed. And the efficacy of combined medication were observed. Results 17 eyes were clinically cured （77.27%）. The treatments of 5 eyes were ineffective, in which 3 eyes received evisceration, and 2 eyes received corneal transplantation. No serious adverse drug reaction occured in all patients. Conclusion Systemic medication of Voriconazole combined with Natamycin eye dorps for the treatment of fungal corneal ulcer is safe and effective. It is a new choice for refractory fungal corneal ulcer.