改良角膜溃疡清创术联合抗真菌药物治疗真菌性角膜溃疡

目的 探讨改良角膜溃疡清创术联合抗真菌药物治疗真菌性角膜溃疡的临床疗效.设计前瞻性病例系列.研究对象入选病例标准：（1）10%KOH湿片直接镜检确诊为真菌性角膜溃疡者;（2）角膜溃疡偏位、浸润较浅,或位于中央但溃疡面积较小者;（3）角膜溃疡浸润深度不明者.2007年1月至2009年12月在山东省眼科研究所青岛眼科医院就诊符合上述标准的141例真菌性角膜溃疡患者.方法 施行改良的角膜溃疡清创术,即剥除角膜溃疡灶坏死及浸润组织,修平溃疡边缘,术后局部频繁应用0.25%两性霉素B或5%那他霉素滴眼液及0.5%氟康唑滴眼液,口服伊曲康唑胶囊等抗真菌药物治疗,评价疗效.主要指标术后角膜溃疡浸润、角膜上皮修复及视力恢复情况.结果 141例患者10%KOH湿片均查见菌丝,术后平均随访时间29天（14～60天）,141例患者真菌性角膜溃疡全部治愈,其中127例行角膜溃疡清创术联合抗真菌药物治疗痊愈,另外14例感染不能控制,根据浸润深度行穿透性角膜移植术（10例）或板层角膜移植术（4例）治愈,且均无复发.127例清创患者平均治愈时间（8.5±6.8）天,患者术前视力≤0.05者29例,0.05～O.3者80例,0.3～1.0者32例,溃疡修复后BCVA≤0.05者6例,0.05～0.3者42例,0.3～1.0者93例（65.96%）,其中0.5.1.0者81例（57.45%）.结论 角膜溃疡清创术联合抗真菌药物是治疗真菌性角膜溃疡的有效方法,患者视力恢复良好,病程明显缩短;对角膜溃疡尚未浸润全层或不能确定者,角膜溃疡清创术后有利于观察浸润深度,指导穿透性或板层角膜移植手术方式的选择.

The modified corneal ulcer debridement combining with anti-fungal medcines for fungal keratitis

Objective To explore the clinical efficacy of modified corneal ulcer debridement combining with anti-fungal agents in the treatment of keratomycosis （fungal corneal ulcer）. Design Prospective case series. Participants Criteria for inclusion： 1 ） fungal corneal ulcer was diagnosed under direct 10% KOH wet film microscopic examination; 2） corneal ulcer located away from the center with superficial infiltration, or located in the center but in small size; 3） depth of corneal infiltration was uncertain. From January, 2007 to December, 2009, 141 cases of fungal corneal ulcer patients in Shandong Eye Institute affiliated to Qingdao Eye Hospital were recruit- ed into this study. Methods All patients received modified corneal ulcer debridement including stripping off ulcer lesion as well as in- filtrated tissue, and repairing ulcer fringe. For postoperative treatment, 0.25% amphotercin B or 5% natamycin and 0.5% fluconazol eye drops were topically administrated with high frequency to the diseased eye. In the meantime, itraconalzole was orally taken as systemat- ic treatment. Clinical efficacy of the above therapy was evaluated at last. Main Outcome Measurs Corneal ulcer infiltration, corneal epithelium reparation and recovery of vision acuity were closely observed following surgery. Results 10% KOH wet film examination showed that hypha was found in all of the 141 cases. The average time for postoperative foUow-up was 29 days （from 14 to 60 days）. All 141 cases of fungal corneal ulcer were completely healed, of which 127 cases were healed by taking corneal ulcer debridement surgery and anti-fungal medication, and the other 14 cases had to take penetrating keratoplasty （10 cases） or lameller keratoplasty （4 cases） due to uncontrolled infection. No recurrence was found during follow-up. The average time for healing in the 127 cases was 8.5 days, and among these cases, 29 cases had a preoperative visual acuity below 0.05, 80 cases between 0.05 and 0.3, and 32 cases be- tween 0.3 and i.0. Postoperative evaluation showed that 6 cases had a visual acuity below 0.05, 42 cases between 0.05 and 0.3, 93 eases （65.96%）between 0.3 and 1.0, and among 93 cases, 81 cases （57.45%） had a visual acuity between 0.5 and 1.0. Conclusions The modified corneal ulcer debridement combining with anti-fungal agents has proved to be an effective treatment for fungal corneal ulcer. It greatly improves patient＇s visual acuity and shortens the disease duration. For cases of superficial or uncertain infiltration, corneal ulcer debridement enables better ulcer observation and provides guidance for further treatment.