角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎

目的:总结角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎的效果。方法:收集2010-09/2011-09在我院就诊的真菌性角膜炎患者30例,对患者进行常规角膜刮片检查,并对全部患者施行角膜溃疡清创术,根据角膜炎的严重程度联合给予氟康唑或那他霉素眼水点眼治疗,清创术治疗无效者采用自体结膜覆盖术及板层角膜移植术治疗,随访观察治疗效果。结果:角膜刮片阳性结果 27例,阳性率90%,2例于外院行共聚焦显微镜检查菌丝阳性;1例为明确植物外伤史的8岁儿童,不能配合真菌检查。轻度角膜炎6例,施行角膜溃疡清创术联合氟康唑眼水点眼治疗全部痊愈,病程2～3wk;中度度角膜炎17例,行角膜溃疡清创术联合那他霉素眼水点眼治疗痊愈12例,病程4～8wk;重度角膜炎7例,行角膜溃疡清创术联合那他霉素眼水点眼治疗痊愈3例,病程8～10wk。角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎有效率70%。结论:角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎操作简单,是一种经济、有效、可行的治疗方式。     

共聚焦显微镜在真菌性角膜炎中的应用

目的:探讨共聚焦显微镜在真菌性角膜炎中的应用价值。方法:回顾性分析在我院就诊的拟诊为真菌性角膜炎患者42例42眼,行共聚焦显微镜检查,同时行角膜病灶组织刮片染色检查。结果:真菌性角膜炎患者42例42眼,行共聚焦显微镜检查,观察到真菌菌丝为39例39眼,检出阳性率93%(39/42),行角膜病灶组织刮片染色镜检,观察到真菌菌丝为30例30眼,检出阳性率71%(30/42)。统计学分析表明两者差异有统计学意义(χ2=6.574,P<0.05)。结论:共聚焦显微镜是一种无创、高效、直观的检查设备,对真菌性角膜炎的初步诊断有着重要的临床价值。     

角膜移植治疗真菌性角膜炎180例临床分析

目的　探讨角膜移植术治疗真菌性角膜炎的临床效果。方法　对临床确诊的 180例 (180只眼 )真菌性角膜炎患者 ,32例行部分板层角膜移植术 (L KP) ,14 8例行穿透性角膜移植术 (PKP)。结果　 172例 (172只眼 )感染控制 ,治愈率为 95 .5 5 %。随访 2～ 2 4个月 ,32例 L KP患者 2 8例植片透明 ,矫正视力 0 .2～ 0 .8,10 9例 PKP患者植片透明 ,矫正视力 0 .0 5～ 1.0 ,两组病例矫正视力比较 ,无显著性差异 (P >0 .0 5 )。 PKP术后的并发症发生率明显高于 L KP。结论　角膜移植术是治疗真菌性角膜炎的有效方法 ,表浅型真菌性角膜炎 L KP术是可行的 ,且并发症少     

真菌性角膜炎70例早期临床诊断分析

目的:分析70例真菌性角膜炎早期临床诊断结果,评价共焦激光显微镜在真菌性角膜炎早期临床诊断中的应用价值。方法:用共焦激光角膜显微镜对临床拟诊为真菌性角膜炎的70例患者进行检查,同时行涂片检查真菌菌丝及培养查真菌菌落,对三组结果进行比较。结果:在70例患者中,根据病史、临床表现确诊为真菌性角膜炎,其中共焦激光角膜显微镜的确诊率为94%(66/70),角膜刮片的确诊率为31%(22/70),培养查真菌菌落确诊率为20%(14/70)。激光共焦角膜显微镜检查检出率高于角膜组织刮片(χ2=29.615,P<0.01)及真菌培养(χ2=39.433,P<0.01)检查。结论:共焦激光角膜显微镜是一种无创、快速、有效的活体检查方法,在真菌性角膜炎的早期诊断、治疗和研究中将起重要作用。     

那他霉素滴眼液治疗真菌性角膜炎疗效观察

真菌性角膜炎是一种致盲率很高的感染性角膜病。近年来其患病率明显增高 ,目前尚无有效的抗真菌滴眼液供临床应用。我院自 1999年 2月至 2 0 0 0年 11月共收治真菌性角膜炎189例 ,随机抽取其中 49例 (4 9眼 )用 5 %那他霉素滴眼液治疗 ,现将观察结果报告如下。1　资料与方法1.1　临床资料　 49例 (4 9眼 )均为单眼发病 ,年龄 14～ 65岁 ,平均 46岁。男 3 4例 ,女 2 5例。植物外伤史 3 0例 ,角膜异物取出史 6例 ,长期使用糖皮质激素者 3例 ,原因不明 10例。有明确外伤史、具有典型的病灶形态并反复病灶刮片查获菌丝或真菌培养阳性为确诊依据…     

荧光染色与过碘酸希夫染色对真菌性角膜炎诊断效果的比较

目的:比较荧光染色和过碘酸希夫染色对真菌性角膜炎(FK)的诊断效果。方法:收集2017年1月至2019年5月于山东第一医科大学附属眼科医院就诊且角膜刮片或真菌培养阳性的FK患者147例角膜标本147份,其中行穿透角膜移植术(PKP)患者84例,板层角膜移植术(LKP)患者42例,病灶切除患者21例;选取11例单纯疱疹病...     

激光共焦显微镜与角膜组织刮片检查在真菌性角膜炎中应用的比较

目的:对比分析激光共焦显微镜检查与角膜组织刮片检查在真菌性角膜炎诊断中的应用.方法:选择2016-05/08来我院治疗的拟诊为真菌性角膜炎患者77例77眼,同时行激光共焦显微镜检查及角膜组织刮片检查,观察图像特点,对比分析两种方法真菌检出率情况.结果:所有患者中,激光共焦显微镜检出阳性66眼,阴性11眼,检出率为86%;角膜组织刮片检查确诊阳性51眼,阴性26眼,检出率为66%,两者比较差异具有统计学意义(P<0.05).结论:激光角膜共焦显微镜检查的安全性和敏感性相对较高,如果能将激光角膜共焦显微镜检查与角膜组织刮片检查联合应用于临床,对提高真菌性角膜炎患者的诊断率具有重要意义.     

共聚焦显微镜在真菌性角膜炎诊治中的临床应用

目的：评价共聚焦显微镜联合角膜刮片在真菌性角膜炎中的临床应用。

方法：对我院临床诊断为真菌性角膜炎的患者56例56眼行共聚焦显微镜检查和角膜刮片检查,包括涂片后显微镜下检查和真菌培养,并进行药物或联合手术治疗,统计诊断的阳性率和治疗预后。

结果：入院时共聚焦显微镜诊断阳性率为91%,角膜刮片病原学检测诊断阳性率为54%,共聚焦显微镜和角膜刮片联合诊断阳性率为95%。治疗后,单纯药物治疗达到临床治愈者44眼(79%),单纯药物治疗无法控制感染需要进行手术治疗者12眼(21%)。

结论：共聚焦显微镜具有非侵入性、快速、重复性好等特点,联合角膜刮片实验室检查可以提高真菌性角膜炎的诊断阳性率,更好地指导治疗。     

镰孢菌属镰刀菌致与接触镜有关的真菌性角膜炎1例(英文)

目的:报道1例罕见的被确诊为由镰孢菌属镰刀菌引起的与接触镜有关的严重的真菌性角膜炎,该病例最后通过治疗性穿透性角膜移植术成功治疗。方法:病例报告。结果:一位39岁的马来西亚女士,私企职员,配戴长戴性软性接触镜18a。感右眼剧痛、眼红10d。眼部检查见多个长有伪足的圆形旁中心角膜溃疡,前房少许积脓,临床诊断为真菌性角膜炎。经重复角膜刮片检查真菌和细菌结果均阴性后给予局部广谱抗生素和抗真菌治疗,但患者右眼角膜炎病情进一步加重,又给予其他的局部和全身抗真菌药物治疗,患者右眼角膜溃疡进一步加深。最后,为保留眼球,限制感染,在发病1.5mo后,给予患者治疗性的穿透性角膜移植术。术后,角膜组织病理学检查和PCR检查证实为镰孢菌属镰刀菌感染所致。结论:这是1例罕见的由镰孢菌属镰刀菌感染引起的严重的与接触镜有关的真菌性角膜炎。这也说明了在真菌性角膜炎的治疗上存在挑战性。为控制真菌性角膜炎进一步发展,并保护眼球,治疗性的穿透性角膜移植术应该是最后的选择。     

43例真菌性角膜炎的诊断及药物治疗临床分析

的分析经药物治疗的真菌性角膜炎病例的早期诊断方法和治疗过程,探讨药物治疗的可行性。方法收集2004年1月至2005年12月在我院经药物治疗的真菌性角膜炎43例,采用角膜刮片镜检加真菌培养鉴定进行诊断,联合2-3种抗真菌药物治疗、根据病情调整用药并观察治疗过程。结果43例经药物治疗的真菌性角膜炎中,35例镜检发现菌丝,39例真菌培养阳性;抗真菌药物治疗疗程18d-56d,5d-7d开始显效,表现为溃疡开始愈合、上皮逐渐修复。全部病例治愈后无复发。结论角膜刮片镜检是早期诊断真菌性角膜炎的有效方法;对发病早期、病情较轻的患者联合抗真菌药物治疗可取得良好疗效。     

恩施地区外伤性真菌性角膜炎回顾性分析

目的 了解恩施地区外伤性真菌性角膜炎临床流行病学特点.方法 回顾性分析2009年7月至2013年6月恩施州中心医院收治的外伤性真菌性角膜炎病例.记录患者人口学特征、病史、职业、致伤原因、病程、先前诊断用药情况,来院后裂隙灯检查、微生物学检查、治疗方法、转归及随访结果,对资料进行分析.结果 4年间,69例（69眼）根据患病诱因、微生物学检查结果诊断为外伤性真菌性角膜炎.随访时间1 ～14个月.男51例,女18例,年龄27 ～71岁.农民64例.主要诱因为植物外伤.外院曾经过微生物学检查诊断为真菌性角膜炎2例.来院后沙氏培养基培养阳性67例,其中镰刀菌属54例（80.6％）,曲霉菌属10例（14.9％）.59例用药物治愈,清创及板层切除术8例,穿透性角膜移植术1例,眼球摘除1例.结论 恩施地区外伤性真菌性角膜炎首位病原体是镰刀菌属,多见于青壮年男性农民,植物外伤是主要原因,可导致严重视力损害.     

角膜板栗刺异物伤15例的临床观察

目的：探讨目前角膜板栗刺异物伤有效治疗方法及影响病情进展的因素。方法：回顾性分析2014－07／2015－10武汉市同济医院眼科病房收治的角膜板栗刺异物伤患者15例15眼的临床资料,入院时未并发真菌性角膜炎的患者在剔除角膜板栗刺异物的同时均积极给予以那他霉素为主的抗真菌治疗,而对入院时已并发真菌性角膜炎的患者予以氟康唑溶液前房冲洗和角膜基质层注药,必要时予以羊膜移植术或角膜移植术,总结上述治疗方法的有效性及影响病情进展的因素。结果：入院时未并发角膜溃疡病例11例,入院时平均病程为1～7（2．42±2．15）d,入院时已并发真菌性角膜溃疡病例4例,入院时病程为3～30（18．25±4．35）d。其中并发角膜溃疡病例板栗刺数量平均为4．5根,并均有板栗刺穿透角膜进入前房;未发生角膜溃疡病例板栗刺数量平均为3．5根,而只有28．5％病例有板栗刺穿透角膜进入前房。经抗真菌治疗和相应手术治疗后,所有病例均被判定为治疗有效。结论：影响角膜板栗刺异物伤病情进展的因素可能有板栗刺的数量、板栗刺是否穿透角膜进入前房、就诊时病程的长短、是否积极进行抗真菌治疗等。对已并发真菌性角膜炎的病例积极予以抗真菌药物能有效控制真菌性角膜炎的进展,为进一步行羊膜移植或角膜移植术创造有利条件。     

Surgical management of fungal endophthalmitis resulting from fungal keratitis

AIM: To report the fungal organisms, clinical features, surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis (EFE) secondary to keratitis, and evaluate the role of surgery in the treatment. METHODS: The clinical records of 27 patients (27 eyes) with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained. RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule, accounting for 56%, 26%, 15% and 2.5%, respectively. Fusarium was identified in 44% (12/27) of the eyes, followed by Aspergillus in 22% (6/27). Posterior segment infection was involved in 78% (21/27) of the patients. The corneal infection was larger than 3 mm ×3 mm in 89% (24/27) of the patients, and 22% (6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes (81.5%) underwent penetrating keratoplasty (PKP), and over half of them (54.5%) were operated within 3d from the onset of antifungal therapy. Fourteen eyes (52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes (55.6%) underwent pars plana vitrectomy (PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60% (9/15), lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes (16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes (18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis. Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy (especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.     

角膜板层清创联合无缝线羊膜移植术治疗表浅真菌性角膜炎

目的：观察角膜板层清创联合无缝线羊膜移植术治疗表浅真菌性角膜炎的临床疗效。

方法：选取2012-04/2013-10在我院确诊的表浅真菌性角膜炎患者经局部+全身抗真菌药物治疗效果欠佳者22例22眼,采用角膜板层清创联合无缝线羊膜移植手术治疗,术中采用生物纤维蛋白粘合剂粘合固定羊膜植片。术后局部抗真菌治疗坚持1～2mo,随访3mo以上,裂隙灯观察角膜愈合、羊膜黏附等情况,共焦显微镜观察羊膜转归、真菌感染复发等。

结果：患者21例术后1～2wk角膜水肿、前房反应逐渐消退,未见羊膜植片脱落、溶解,未见羊膜下积液等; 2wk后羊膜植片逐渐与角膜融为一体,创面逐渐增厚,角膜上皮重建、透明度增加; 4wk后病变区逐渐瘢痕化,荧光素染色阴性; 3mo后角膜创面遗留程度不等的角膜云翳或斑翳,视力较术前有不同程度提高。其中19例术后4wk羊膜基本或完全吸收。术后1例真菌感染复发,经板层角膜移植后治愈。

结论：角膜板层清创联合无缝线羊膜移植可有效清除炎症病灶,提高局部药效,缩短手术时间,减轻术后反应,促进角膜愈合,是治疗表浅真菌性角膜炎的一种有效方法。     

Study of the first contact management profile of cases of infectious keratitis: a hospital-based study

PURPOSE: To study the management pattern and examine the role of cultures and antibiotic sensitivity testing in infectious keratitis. METHODS: A retrospective analysis of the demographic, clinical, and microbiological data was performed in 100 consecutive patients with infectious keratitis. The main parameters evaluated were nature of first contact with the health care services, investigations undertaken, treatment initiated, and the time interval between presentation to the first medical contact and to our center. Finally, the reports of culture and antibiotic sensitivity testing undertaken at our center were evaluated. RESULTS: In 70% of cases, ophthalmologists in independent practice were the first medical contact. Direct microscopy of the corneal scraping was undertaken in only 6% of cases, whereas culture and sensitivity studies had not been performed in any of the patients. Forty-six percent of the patients were prescribed 0.3% ciprofloxacin eyedrops in an inadequate dosage. Broad-spectrum fortified antibiotics eye drops had not been prescribed in any of the cases. At our center, positive cultures were obtained in 73.86% of cases and the most common organism isolated was coagulase-negative Staphylococcus (33.84%), followed by Pseudomonas aeruginosa (15.38%). A large number of the isolates demonstrated resistance to the recommended antibiotic therapy. CONCLUSIONS: Failure to implement standard management protocol for infectious keratitis at first contact is a major factor contributing to ocular morbidity in India.     

Treatment of fungal keratitis by penetrating keratoplasty

AIM: To study the use of penetrating keratoplasty (PKP) for the treatment of severe fungal keratitis that could not be cured by antifungal medication. METHODS: A retrospective analysis of 108 cases of severe fungal keratitis in which PKP was performed served as the basis for this study. Fungal keratitis was diagnosed by KOH staining of corneal scrapings or by confocal microscopic imaging of the cornea. All patients received a combination of topical and oral antifungal medicines without steroids as the first course of therapy. Patients whose corneal infection was not cured or in whom the infection progressed during antifungal treatment were given a PKP. After surgery, the patients continued to receive antifungal therapy with gradual tapering of the dose over a 1-2 month period. Cyclosporine was used to prevent graft rejection beginning 2 weeks after PKP. Topical steroid only was administered to the patient whose donor graft was over 8.5 mm and with a heavy iris inflammation 2 weeks after PKP. The surgical specimens were used for microbiological evaluation and examined histopathologically. The patients were followed for 6-24 months after PKP. Graft rejection, clarity of the graft, visual acuity, and surgical complications were recorded. RESULTS: Corneal grafts in 86 eyes (79.6%) remained clear during follow up. There was no recurrence of fungal infection and the visual acuity ranged from 40/200 to 20/20. Complications in some patients included recurrent fungal infection in eight eyes (7.4%), corneal graft rejection in 32 eyes (29.6%), secondary glaucoma in two eyes (1.9%), and five eyes (4.6%) developed cataracts. 98 of 108 of the recipient corneas had PAS positive fungal hyphae in tissue sections; 97 of 108 were culture positive for various fungi, including Fusarium (63), Aspergillus (14), Candida (9), Penicillium (4), and seven cases in which septate hyphae were seen but identification of the organism was not conclusive. CONCLUSIONS: PKP is an effective treatment for fungal keratitis that does not respond to antifungal medication. Early surgical intervention before the disease becomes advanced is recommended. It is critical that the surgical procedure remove the infected tissue in its entirety in order to effect a cure.     

Predisposing factors and etiologic diagnosis of ulcerative keratitis

PURPOSE: To determine the predisposing factors, demographic characteristics, and etiology of ulcerative keratitis in a referral center in Bangkok, Thailand. METHODS: The medical records of admitted patients with positive-culture ulcerative keratitis were retrospectively reviewed for demographic data, predisposing factors, and microbial culture results. Predisposing factors were compared between bacterial and fungal keratitis. RESULTS: From January 2001 to December 2004, there were 127 positive-culture ulcerative keratitis cases. The most frequent microbiological diagnosis was bacterial keratitis (76 eyes, 60%), followed by fungal (48 eyes, 38%) and Acanthamoeba keratitis (3 eyes, 2%). The most common organisms isolated were Pseudomonas spp. for bacteria and Fusarium spp. for fungus. Compared with bacterial keratitis, fungal keratitis was more likely to be associated with ocular trauma (odds ratio = 11.20; 95% confidence interval, 3.62-34.66) but less likely to be associated with contact lens wear (odds ratio = 0.02; 95% confidence interval, 0.01-0.08). CONCLUSIONS: In our study, Pseudomonas and Fusarium species are the most common causes of bacterial and fungal keratitis, respectively. Fungal keratitis was more likely than bacterial keratitis to be associated with ocular trauma, whereas fungal keratitis was less likely to be associated with contact lens wear.     

Acanthamoeba keratitis after photorefractive keratectomy

A 37-year-old women developed severe suppurative keratitis immediately after having photorefractive keratectomy in her left eye. The keratitis was unresponsive to intensive topical antibiotic agents and topical and systemic steroids. Although the differential diagnosis included nonmicrobial and fungal keratitis, the clinical course and confocal microscopy suggested, and subsequent histopathologic examination confirmed, a diagnosis of Acanthamoeba keratitis. The amebic contamination probably resulted from exposure of the deepithelialized cornea to contaminated freshwater in a northern Wisconsin marsh. This case emphasizes the importance of encouraging patients with epithelial defects and bandage soft contact lenses to avoid exposure to contaminated freshwater until reepithelialization is complete.     

Fungal colonization and infection in Boston keratoprosthesis

PURPOSE: To determine the incidence of and risk factors for fungal keratitis and endophthalmitis in patients with a Boston keratoprosthesis (KPro) and to determine whether surveillance cultures were helpful in predicting fungal infection. METHODS: A retrospective chart review was performed of 182 patients (202 eyes) who received a type 1 (through cornea) or type 2 (through cornea and lid) KPro between March 1, 1990, and December 31, 2004, and who were followed for at least 1 month (range, 1 month to 13 years; mean, 2.84 years). There were 148 eyes with type 1 and 54 eyes with type 2. Beginning in late 1999, many eyes were given a prophylactic topical regimen containing vancomycin, and many eyes with type 1 KPro were given therapeutic contact lenses. Cases of fungal keratitis or endophthalmitis were analyzed. To determine the fungal colonization rate, 70 surveillance cultures of the ocular or lid surface around the KPro optic were obtained of 36 uninfected KPro eyes (35 patients) at random time-points over 1 year (August 2002 to July 2003). RESULTS: There were 4 definite and 1 probable fungal infections in 6893 patient-months of follow-up, or 0.009 fungal infections per patient-year. These included 3 cases of definite or probable Candida endophthalmitis (C. parapsilosis, C. glabrata, and C. albicans) and 2 cases of mold keratitis (Alternaria, Fusarium). The rate was higher in eyes receiving a vancomycin-containing topical prophylactic regimen than those with on a non-vancomycin regimen (5 cases/2774 person-months vs. 0 cases/4119 person-months; P = 0.011). In eyes with type 1 KPro, the rate was higher with therapeutic contact lens wear than without (4/1682 vs. 0/3115 person-months; P = 0.015). Surveillance cultures did not predict fungal infection, and none of the 6 surveillance eyes colonized with fungi (all Candida) developed a fungal infection. The prevalence of fungal colonization in KPro eyes had not changed since our 1996 surveillance study (11% vs. 10%, P > 0.05). CONCLUSION: Fungal infections in KPro eyes have appeared since we introduced broad-spectrum antibiotic prophylaxis and therapeutic contact lenses 5 years ago, but the infection rate remains very low in our mostly New England-based patient population. Cleaning or replacing the contact lens on a regular basis and prescribing a short course of topical amphotericin at the first visible signs of fungal colonization may prevent these infections.