Natamycin in the treatment of fungal keratitis:a systematic review and Meta-analysis

AIM: To review published clinical studies examining the effect of natamycin in the treatment of fungal keratitis.METHODS:We selected the publications in CENTRAL, MEDLINE, EMBASE, CNKI, and CBM. This study systematically reviewed published randomized controlled trials (RCTs) that compared natamycin to other antifungal agents, and conducted feasible Meta-analysis of efficacy results using Revman 5.2 software.RESULTS: We included seven trials which were mainly carried out in developing countries of Asia, with five trials conducted in India, one each in China and Bangladesh. A total of 804 participants were randomized to following comparisons:2% econazole versus 5% natamycin showed little difference in the effects of treatment of fungal keratitis [RR=0.99, 95% confidence interval (CI), 0.8 to 1.21]; chlorhexidine gluconate versus 5% natamycin indicated that the results on healing of the ulcer at 21d was less conclusive (RR=0.77, 95% CI, 0.55 to 1.08; I²=0%); 1% voriconazole versus 5% natamycin suggested that natamycin treatment appeared to be significantly better outcomes than voriconazole (regression coefficient =-0.18 logMAR; 95% CI, -0.30 to -0.05; P=0.006), especially in Fusarium cases (regression coefficient=-0.41 logMAR; 95% CI, -0.61 to -0.20; P<0.001); natamycin versus fluconazole showed a significant difference in cure rate (χ² =5.048, P<0.05) and natamycin group was more effective than fluconazole in average period of therapy (t=7.94, P<0.01).CONCLUSION: Natamycin was a preferable choice in the treatment of fungal keratitis, especially in the early period of Fusarium cases.     

眼部真菌感染的病原学及体外药物敏感性分析

目的 分析4年间眼部感染的真菌菌属分布及其体外药物敏感性。方法 收集2179份眼部标本进行分离培养，对真菌培养阳性率、菌属的种属分布、菌属的季节分布及年龄与性别分布进行回顾性分析；同时分析培养阳性的真菌对常用抗真菌药物的敏感性。结果 共培养阳性菌株681株，阳性率为31．25％，其中镰刀菌属394株（57．86％），曲霉菌属116株（17．03％）。培养阳性的标本中，角膜591株（86．78％）、房水29株（4．26％）、结膜22株（3．23％）、玻璃体22株（3．23％）、泪囊1株（0．15％）、其他16株（2．35％）。体外药物敏感性观察发现，镰刀菌中368株对那他敏感（93．40％），曲霉菌中107株对伊曲康唑敏感（92．24％）。结论 镰刀菌属及曲霉菌属仍是我国北方主要的眼部致病真菌菌属；镰刀菌对那他霉素最敏感，曲霉菌对伊曲康唑最敏感。     

Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluoroquinolones and gentamicin plus cephalothin

PURPOSE: Patients presenting with presumed infective keratitis were studied to determine predisposing factors, the current susceptibilities of the bacterial isolates to a range of relevant antibiotics, the success rate of topical antibiotic treatment of keratitis and predictors of failure of topical therapy. METHODS: Corneal scrapings taken from patients who presented between January 2002 and December 2003 to the Sydney Eye Hospital Emergency Department with keratitis were cultured. The minimum inhibitory concentration of selected antibiotics was determined for each bacterial isolate using an agar dilution technique. RESULTS: One hundred and twelve consecutive patients presented with corneal ulcers. Forty-seven of the 112 (42%) patients had a growth from the corneal scraping. Potential predisposing factors were identified in 64% of patients, most frequently contact lens wear (36% of patients). Coagulase-negative staphylococci were the most common species isolated. Other common organisms isolated include Pseudomonas aeruginosa, Corynebacterium spp., Staphylococcus aureus and Streptococcus spp. CONCLUSIONS: Most microorganisms isolated from patients with bacterial keratitis showed susceptibility to ciprofloxacin and aminoglycosides. Cephalothin plus aminoglycoside constituted an effective initial broad-spectrum antibiotic combination. The success rate of topical antibiotic treatment of corneal abscess is 89%. Predictors of failure include older age group, medium or large ulcer, culture-negative keratitis, hypopyon and poor visual acuity.     

真菌性角膜炎预后影响因素分析

目的:分析影响真菌性角膜炎预后的相关因素,为真菌性角膜炎治疗决策提供依据。方法:选择我院诊治的105例105眼真菌性角膜炎患者,通过评估临床体征、实验室检查及治疗情况等对真菌性角膜炎的预后影响因素进行统计分析。结果:选取105眼中49眼药物治疗治愈(46.7%);30眼(28.6%)药物治疗有效,上皮延迟愈合,26眼(24.8%)治疗失败。结论:抗真菌治疗开始于症状出现7d以后、初诊病灶浸润面积>16mm2、前房积脓>2mm、菌种鉴定为镰孢菌的真菌性角膜炎患者药物治疗预后较差。     

Evaluation of antifungal susceptibility and clinical characteristics in fungal keratitis in a tertiary care center in North India

Purpose:To study the antifungal susceptibility of common corneal pathogenic fungi to antifungal agents in the North Indian population.Methods:Prospective study of the antifungal sensitivity testing (natamycin, amphotericin B, voriconazole, itraconazole, fluconazole, posaconazole, caspofungin, micafungin) of fungal isolates from 50 cases of culture positive fungal keratitis by using E test method. Details noted included demographic data, visual acuity, clinical details, grade of keratitis, healing time, and success in medical management.Results:Of 50 patients with fungal keratitis (mean age: 40.28 ± 16.77 years), 12 eyes healed within 3 weeks, 14 had a delayed healing response, and 24 had chronic keratitis. Among the 15 cases of Fusarium isolates, 93.3% were sensitive to natamycin, while 40% to amphotericin B; 66.6% to voriconazole, 13.4% to itraconazole and fluconazole each. 80% of Fusarium cases (n = 12) showed susceptibility to posaconazole. Among Aspergillus flavus isolates, 53.4% (n = 8) were sensitive to natamycin, with only 40% (n = 7) showing sensitivity to amphotericin B and good susceptibility to azoles. MIC against susceptible Fusarium spp. for natamycin was 3–16 µg/mL, amphotericin B: 1–8 µg/mL, voriconazole: 0.5–1.5 µg/mL, itraconazole: 0.5–12 µg/mL, posaconazole: 0.094–1.5 µg/mL. MIC against Aspergillus flavus was natamycin: 8–32 µg/mL, amphotericin B: 0.5–16 µg/mL, voriconazole: 0.025–4 µg/mL, itraconazole: 0.125–8 µg/mL, posaconazole: 0.047–0.25 µg/mL; against Aspergillus niger isolates, to natamycin was 6 µg/mL (n=1), amphotericin B 8–12 µg/mL (n = 3), voriconazole: 0.125–0.19 µg/mL (n = 3), itraconazole: 0.38–0.75 µg/mL, posaconazole: 0.064–0.19 µg/mL and against Aspergillus fumigatus (n = 1), was natamycin4 µg/mL, amphotericin B - 8 µg/mL, voriconazole 0.25 µg/mL, itraconazole 1 µg/mL, and posaconazole 0.19 µg/mL. MIC against susceptible Acremonium spp. for natamycin was 1.5–16 µg/mL, amphotericin B: 0.5–8 µg/mL, voriconazole: 0.19–3 µg/mL, itraconazole: 0.125 µg/mL, posaconazole: 0.125–0.5 µg/mL and against susceptible Curvularia was natamycin 0.75–4 µg/mL, amphotericin B 0.5–1 µg/mL, voriconazole 0.125–0.19 µg/mL, itraconazole 0.047–0.094 µg/mL, posaconazole 0.047–0.094 µg/mL. MIC against Mucor spp.+ Rhizopus spp. (n = 1) was natamycin: 8 µg/mL, amphotericin B: 0.75 µg/mL, posaconazole: 1.5 µg/mL. MIC against of Alternaria (n = 1) was voriconazole: 0.19 µg/mL, posaconazole: 0.094 µg/mL. MIC against Penicillium (n=1) was natamycin: 8 µg/mL, voriconazole: 0.25 µg/mL, itraconazole: 0.5 µg/mL, and Posaconazole: 0.125 µg/mL.Conclusion:Our observations highlight the variations in susceptibility to antifungal agents. Posaconazole seems to be effective with low MIC against common corneal pathogenic fungal isolates.     

那他霉素联合重组牛碱性成纤维细胞生长因子眼用凝胶治疗真菌性角膜溃疡的疗效

目的:探讨那他霉素、重组牛碱性成纤维细胞生长因子眼用凝胶点眼联合碘酊烧灼治疗真菌性角膜溃疡的疗效。方法:将160例真菌性角膜溃疡的患者随机分为治疗1组(60例)、治疗2组(67例)和对照组(33例)。三组病例均先行局部清创碘酊烧灼术,治疗1组采用50g/L那他霉素滴眼液点眼,治疗2组采用50g/L那他霉素滴眼液及重组牛碱性成纤维细胞生长因子眼用凝胶点眼,对照组使用2g/L氟康唑滴眼液点眼,比较三组病例的治愈率和疗程。结果:三组治愈率分别为71.7%,76.1%,51.5%,有效率分别为90.0%,91.0%,78.8%。治疗1,2组分别与对照组相比,差异有统计学意义(P<0.05)。三组中治愈病例的平均治愈时间分别为20±15,16±12,30±13d,治疗组与对照组比较均有显著统计学意义。结论:抗真菌药物50g/L那他霉素滴眼液及细胞生长因子重组牛碱性成纤维细胞生长因子眼用凝胶与传统的碘酊烧灼法联合治疗真菌性角膜溃疡,尤其是早期患者,具有重要意义。     

流式细胞术检测眼部镰刀菌对两性霉素B和氟康唑的药物敏感性

目的探讨流式细胞术测定眼部镰刀菌对抗真菌药物敏感性的可行性。方法用流式细胞术药敏试验（FCST）和标准药敏试验（肉汤稀释法M38-A）法检测24株镰刀菌对两性霉素B（AMB）和氟康唑（FCZ）的敏感性,比较2种方法所得结果的一致性。结果FCST法检测AMB的最低抑菌质量浓度（MIC）为2~8μg/mL,FCZ的MIC除1株为32μg/mL外,其余均≥64μg/mL。2种检测方法的一致性在1个稀释度范围内为83.3%（AMB）和87.5%（FCZ）,在2个稀释度范围内为91.6%（AMB）及100%（FCZ）,差异均无统计学意义（P=0.568,0.257）。结论FCST法是一种快速、敏感、准确的药敏试验方法,可用于检测镰刀菌对抗真菌药物的敏感性。     

常用滴眼液体外抗菌敏感性比较

为比较临床常用滴眼液的体外抗菌敏感性，为临床选择提供参考，采用含各种滴眼液等体积量的自制药敏纸片，操作程序按Ｋｉｒｂｙ－Ｂａｕｅｒ纸片扩散法，比较抑菌圈直径，＞＝２０ｍｍ设为敏感，＜＝１５ｍｍ为耐药，１６—１９ｍｍ为中敏，分析各滴眼液抗菌活性。结果氟喹诺酮类滴眼液抗菌谱广且抗菌活性强，其中又以环丙沙星滴眼液抑菌效果最佳。其次为丁胺卡那和庆大霉素，氯霉素、多粘菌素Ｂ、红霉素和利福平的抗菌作用较差。结论氟喹诺酮类滴眼液，尤其是环丙沙星滴眼液，是眼科临床理想的抗菌药物。     

Understanding the science of fungal endophthalmitis - AIOS 2021 Sengamedu Srinivas Badrinath Endowment Lecture

Fungal endophthalmitis is a potentially blinding condition. It is more often reported from Asia, including India. The incidence is lower than bacterial endophthalmitis. But it is relatively more challenging to treat than bacterial endophthalmitis. Many eyes may need therapeutic keratoplasty and/or evisceration. The current mainstays of treatment are vitrectomy irrespective of the presenting vision, intravitreal antifungal agents, and systemic therapy; additionally, the patients could require prolonged treatment with repeat vitreous surgeries and intravitreal injections. Difficulty in clinical diagnosis, delay in microbiological culture, and limited options of antifungal drugs make the treatment more difficult and less rewarding. Three common fungi causing endophthalmitis are Aspergillus, Fusarium, and Candida. The former two are molds, often identified in exogenous endophthalmitis, postoperative and traumatic; the latter is yeast and is more often identified in endogenous endophthalmitis. A faster diagnosis with newer molecular microbiological technologies might help institute treatment earlier than it is currently possible. A target trial using big data from different regions of the world might emulate a randomized clinical trial to design a definite treatment strategy. Given fewer antifungal drugs, one must be mindful of antifungal stewardship to prevent resistance to the existing drugs.     

伏立康唑对眼部常见分离真菌的体外药敏实验研究

目的探讨新一代氮唑类抗真菌药伏立康唑(VCZ)对眼部常见分离真菌的体外抗菌活性,并与两性霉素B(AMB)、氟康唑(FCZ)作对比。方法参照美国临床实验室标准化委员会(NCCLS)制定的M38-A方案,共对3属43株眼部常见分离真菌进行研究,VCZ、AMB和FCZ体外单独用药时分别取100%、100%和≥80%的生长抑制为最低抑菌浓度(MIC),质控菌株采用近平滑念珠菌(Candidaparapsilosis,ATCC22019)。结果VCZ对白色念珠菌的MIC90最低(0.016μg/mL),对镰刀菌菌属的MIC90值偏高(4μg/m),对曲霉菌属的MIC50、MIC90分别为0.125μ/mL和1斗g/mL,明显低于AMB(分别为0.5、2μg/mL)。除白色念珠菌外的其他眼部分离菌株对FCZ耐药(MIC90≥128μg/mL)。VCZ对镰刀菌和曲霉菌的体外抑制率均为100%,高于AMB的61.5%和46.7%。结论VCZ对眼部常见分离真菌均有显著的体外抗菌活性,其眼用剂型的开发对临床上治疗真菌性角膜溃疡具有重要的意义。     

Th1/Th2细胞因子在小鼠真菌性角膜炎中的表达

目的 通过检测Th1/Th2细胞因子在小鼠真菌性角膜炎中的表达水平,探讨机体免疫在该病发展中的作用. 方法应用角膜表层镜法建立Balb/c小鼠茄病镰刀菌性角膜炎模型,在感染后第1、3、5、7天,裂隙灯显微镜观察角膜炎特点;HE染色观察角膜病理变化;半定量RT-PCR和ELISA检测角膜中Thl细胞因子(IFN-γL-12)及Th2细胞因子(IL-4、IL-10)基因mRNA和蛋白的表达,半定量RT-PCR检测T-bet基因mRNA的表达;直线相关分析检测T-bet mRNA与IFN-比值的相关性. 结果角膜接种菌液后,早期角膜浸润混浊进行性加重,第5天后新生血管大量生长;HE染色可见第1、3天在角膜缘、角膜基质及前房中有大量的炎症细胞浸润,第5天后炎症细胞减少,角膜基质中纤维细胞逐渐增多;RT-PCR与ELISA检测结果表明,Thl细胞因子(IFN-γL-12)和Th2细胞因子(IL-4、IL-10)基因mRNA及蛋白在角膜接种菌液后均出现表达,且IFN-γL-12的表达显著强于IL-4、IL-10;IFN-γ/IL-4比值在第3天达最高值,而后逐渐降低;T-bet mRNA在第3天达最高值;T-bet mRNA的表达与IFN-γ/IL-4比值呈正相关(P＜0.05). 结论在真菌性角膜炎中,Thl/Th2型免疫应答共同参与调节机体的抗真菌免疫,但以Th1型应答为主;角膜感染真菌后第3天机体的免疫力达最强.     

国产那他霉素滴眼液治疗真菌性角膜溃疡的临床研究

目的:评价国产那他霉素滴眼液与进口那他霉素滴眼液对真菌性角膜溃疡的临床疗效。方法:采用随机、对照和双盲方法随机选择2010-09/2011-03在沈阳爱尔眼科医院及哈尔滨爱尔眼科医院诊断明确的真菌性角膜溃疡患者20例20眼,以随机数字表法随机分为两组,治疗组12例应用50g/L国产那他霉素滴眼液,对照组8例应用50g/L进口那他霉素滴眼液。开始应用剂量,每30min滴眼1次共3d;如有效,则调整为每小时1次共2d;每2h1次共5d;每3h1次共2wk,疗程21～30d,两组均联合全身应用抗真菌药物。局部治疗7d若患眼体征恶化或不见好转者,更换抗真菌药物或联合其它药物治疗。分别在用药后3,5,7d对临床疗效进行评估。采用Fisher精确检验对数据进行统计学分析两组之间的疗效差异。结果:治疗组临床治疗有效率为58.3%,对照组有效率75%,Fisher精确检验结果显示组间治疗有效率无统计学差异(P>0.05)。结论:国产那他霉素滴眼液能够有效治疗真菌性角膜溃疡。     

Clinical results of topical fluconazole for the treatment of filamentous fungal keratitis

Background Fungal keratitis is a rare but serious condition that may result in loss of vision. The potentially poor prognosis might be due to a delay in diagnosis and/or to limited treatment options. The aim of this study is to evaluate the clinical outcome of patients treated with topical fluconazole 0.2% for the treatment of filamentous fungal keratitis.Methods Retrospective case series. A chart review of all patients evaluated at the Ophthalmology Department of the Hospital de Clínicas in Paraguay from January 1997 to December 2000 identified 25 cases of fungal keratitis. Among these cases, one patient discontinued the treatment and another received amphotericin as the first line drug, resulting in 23 cases available for data analysis. Twelve patients were treated with topical fluconazole 0.2% alone (Group I) and 11 patients received a combination of topical fluconazole 0.2% and oral ketoconazole 200 mg twice daily (Group II).Results Sixteen of 23 cases showed resolution of the keratitis, 9/12 (75%) in Group I and 7/11 (64%) in Group II. Seven patients (30%) did not respond to medical treatment and required a surgical procedure to preserve eye integrity. Superficial and small ulcers have a significantly better prognosis than do lrge and deep ulcers. Concomitant oral ketoconazole (400 mg/day) did not improve the clinical results.Conclusions Our findings of study suggest that topical fluconazole 0.2% is a safe and effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases that are not severe. The addition of oral ketoconazole to topical fluconazole did not improve the clinical outcome.None of the authors has any financial interest in the materials used on this study.     

The patterns of in vitro antimicrobial susceptibility and resistance of bacterial keratitis isolates in Glasgow,United Kingdom

Purpose: Trends in antibiotic sensitivity of pathogenic bacteria change with time and the emergence of resistance to commonly used antibiotics is not uncommon. The aim of this study is to identify the antibiotic susceptibility and resistance patterns in a tertiary referral centre that commonly manages corneal infections. Methods: This is a retrospective review of microbiology reports of corneal scrapes in a tertiary care hospital. Results: There were 205 positive corneal scrapes (32 per cent) in 1995 to 1998 and 147 (28 per cent) in 2004 to 2007. There was increased incidence of Staphylococcus aureus (18 to 21 per cent) (p = 0.16), Moraxella catarrhalis (1.5 to 5 per cent) (p = 0.5), pseudomonas species (6 to 14.5 per cent) (p = 0.25) and non‐lactose fermenting coliforms (1.5 to 7 per cent) (p = 0.5). In vitro resistance of gram‐positive bacterial isolates to ciprofloxacin was increased from 5 to 7 per cent (p = 0.5). The in vitro susceptibility of gram‐positive organisms to dual therapy with cefuroxime and gentamicin were 98 per cent in 1995 to 1998, and 94 per cent in 2004 to 2007 (p = 0.1). Pseudomonas species were 100 per cent susceptible to cefuroxime in the first period but developed 100 per cent resistance in the later period (p = 0.0002). However, the susceptibility of gram negative bacterial isolates to dual therapy with cefuroxime and gentamicin (p = 1) and monotherapy with ciprofloxacin (p = 1) was 100 per cent in both periods. The in vitro resistance to chloramphenicol to gram‐positive organisms was reduced to 5 from 12 per cent (p = 0.19) but there was an increase in resistance of gram‐negative organisms from 23 to 36 per cent (p = 0.3). Conclusion: Despite limitations, this study demonstrates that the fortified antibiotics such as 5% cefuroxime 1.5% gentamicin may be the appropriate choices for most episodes of bacterial keratitis, either as an initial therapy or after identification of in vitro susceptibility of bacterial isolates.     

板层角膜切除术联合那他霉素治疗真菌性角膜溃疡的临床及病理研究

目的：研究板层角膜切除术联合那他霉素治疗真菌性角膜溃疡的临床疗效及组织病理学基础。方法：选取2009-12/2011-11真菌性角膜溃疡患者32例32眼,角膜病变未累及内皮层,行角膜板层切除联合那他霉素滴眼治疗,观察记录治疗前后视力、角膜情况、病程、并发症及致病菌种类,对切除组织行组织病理学检查。结果：治疗前视力≤0.05者20眼,～0.3者11眼,〉0.3者1眼。板层切除术后联合那他霉素治疗痊愈28例（87.5%）,治愈时间7～32（平均13.2±8.5）d,痊愈时视力≤0.05者5眼,～0.3者8眼,〉0.3者15眼。病情控制不良改行角膜移植术者4例。31例真菌培养阳性（96.9%）,其中镰刀菌18例,曲霉菌属8例,链格孢霉3例,未知菌属2例。病理学检查显示溃疡灶中有多量中性粒细胞浸润,过碘酸-希夫（PAS）染色显示角膜组织中菌丝多数位于角膜浅层,并呈与板层胶原纤维平行方向生长,但也有少数呈斜形或垂直生长方式,侵及切除组织全层。不同菌属之间菌丝在角膜中生长方式无明显差异。结论：对于病变未累及全层的真菌性角膜溃疡患者,及时行板层角膜切除术可大大提高那他霉素药物治疗有效性,缩短病程,恢复视力。     

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。     

真菌性角膜炎患者的临床特征及病原菌分布

目的：：分析真菌性角膜炎的临床特征及病原菌的分布,为临床诊疗提供依据。方法：回顾性分析2012-01/2015-07在长江大学附属第一医院诊治的98例98眼真菌性角膜炎患者的临床资料。结果：真菌性角膜炎最主要由植物外伤引起,其次是糖皮质激素的应用及隐形眼镜的不当使用。几乎所有患者出现菌丝苔被、伪足、免疫环、卫星灶等体征,少数患者出现内皮斑和前房积脓。真菌性角膜炎的致病菌主要以镰刀菌属为主(73.5％),其次为曲霉属(13.2％)、念珠菌属(9.2％),其他菌属4.1％。65例65眼患者在选择5％那他霉素滴眼液后治愈,15例15眼患者病情明显好转,其余18例18眼患者病情无明显好转,联合伏立康唑后13例13眼病情好转,5例5眼病情继续恶化,最终3例3眼羊膜遮盖,2例2眼眼球摘除。。结论：真菌性角膜炎在荆州地区的主要流行菌种为镰刀菌。那他霉素眼液可作为临床预防和治疗真菌性角膜炎首选药物。临床医师应加强对真菌性角膜炎的了解,以便早期诊断和及时治疗。     

Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: Experience of over a decade

Purpose:

To review the epidemiological characteristics, microbiological profile, and treatment outcome of patients with suspected microbial keratitis.

Materials and Methods:

Retrospective analysis of a non-comparative series from the database was done. All the patients presenting with corneal stromal infiltrate underwent standard microbiologic evaluation of their corneal scrapings, and smear and culture-guided antimicrobial therapy.

Results:

Out of 5897 suspected cases of microbial keratitis 3563 (60.4%) were culture-proven (bacterial – 1849, 51.9%; fungal – 1360, 38.2%; Acanthamoeba – 86, 2.4%; mixed – 268, 7.5%). Patients with agriculture-based activities were at 1.33 times (CI 1.16–1.51) greater risk of developing microbial keratitis and patients with ocular trauma were 5.33 times (CI 6.41–6.44) more likely to develop microbial keratitis. Potassium hydroxide with calcofluor white was most sensitive for detecting fungi (90.6%) and Acanthamoeba (84.0%) in corneal scrapings, however, Gram stain had a low sensitivity of 56.6% in detection of bacteria. Majority of the bacterial infections were caused by Staphylococcus epidermidis (42.3%) and Fusarium species (36.6%) was the leading cause of fungal infections. A significantly larger number of patients (691/1360, 50.8%) with fungal keratitis required surgical intervention compared to bacterial (799/1849, 43.2%) and Acanthamoeba (15/86, 17.4%) keratitis. Corneal healed scar was achieved in 75.5%, 64.8%, and 90.0% of patients with bacterial, fungal, and Acanthamoeba keratitis respectively.

Conclusions:

While diagnostic and treatment modalities are well in place the final outcome is suboptimal in fungal keratitis. With more effective treatment available for bacterial and Acanthamoeba keratitis, the treatment of fungal keratitis is truly a challenge.     

眼部分离培养棒状杆菌属的分布及耐药性分析

目的分析眼部分离棒状杆菌的分布、鉴定及药敏结果,讨论该菌属在眼部感染中的临床意义。设计实验研究。研究对象北京同仁医院眼科患者眼部分离的171株棒状杆菌属。方法由专业人员取材,对眼部分离细菌培养标本接种、培养,采用法国生物梅里埃棒状杆菌生化反应鉴定条（API Coryne）鉴定44株／171株菌株,并用纸片扩散法检测耐药性,进行12种抗生素临床测定。主要指标棒状杆菌种类及耐药情况。结果171株棒状杆菌主要来源于结膜（57．8％）和角膜（27．2％）。鉴定的菌株可分为9种,其中麦氏棒状杆菌21株（47．7％）,拥挤棒状杆菌6株（13．6％）,水生棒状杆菌和丙酸棒杆菌各4株（9．0％）。药物敏感率依次为万古霉素100％（37株）,替考拉宁90．2％（51株）,利福平85．9％（128株）,阿米卡星85．1％（134株）,庆大霉素84．3％（134株）,妥布霉素82．1％（134株）。结论麦氏棒状杆菌可能是中国北方眼部感染最常见的棒状杆菌。万古霉素对棒状杆菌属抑菌作用最好。     

无孢霉菌性角膜炎患者的临床特征及治疗转归

目的　探讨无孢霉菌性角膜炎患者的临床特征及治疗转归。方法　选择2009年3月至2019年3月在山东第一医科大学附属眼科医院诊断为无孢霉菌性角膜炎的患者64例（64眼）,对患者的临床特征、实验室检查、治疗方法和转归进行分析。结果　64例（64眼）中,15例（23.4％）为中浅基质层溃疡和浸润,20例（31.3％）为深基质层溃疡和浸润,29例（45.3％）为深基质层溃疡和全层浸润。26例（40.6％）伴有前房积脓,5例（7.8％）伴有角膜穿孔,所有患者真菌培养均未见孢子生长。9例患者行药物治疗,11例患者接受角膜病灶切除术或结膜瓣遮盖术,17例患者行板层角膜移植术（LKP）,24例患者行穿透性角膜移植术（PKP）,3例患者行眼内容摘除术。总复发率为23.0％（14/61）,其中药物治疗后复发率为22.2％（2/9）,LKP后复发率为11.8％（2/17）,PKP后复发率为41.7％（10/24）,不同治疗方法之间复发率差异有统计学意义（χ²＝11.268,P<0.05;因行眼内容摘除术后无复发可能,统计中未计入眼内容摘除术患者）,LKP组与PKP组患者复发率差异无统计学意义（P＞0.05）。术前合并穿孔的患者复发率为75.0％（3/4）,高于无穿孔患者的复发率19.3％（11/57）,差异有统计学意义（P<0.05）。前房积脓患者的复发率为30.4％（7/23）,高于无前房积脓患者的复发率18.4％（7/38）（P＞0.05）。8例患者最终感染无法控制行眼内容摘除术,总治愈率为87.5％。复发患者总体治愈率为64.3%（9/14）。结论　无孢霉菌性角膜炎是一种严重的进行性感染性角膜疾病,角膜移植术后复发率高、预后差,应引起临床医师重视。