角膜基质内注射氟康唑联合匹马霉素滴眼液治疗真菌性角膜炎的疗效观察

目的观察角膜基质内注射氟康唑联合匹马霉素滴眼液治疗真菌性角膜炎的疗效。方法选择常规用药方式治疗无效的真菌性角膜炎患者42例（42只眼）,在匹马霉素滴眼液点眼治疗的基础上采用0.2%氟康唑角膜基质内注射,观察其疗效及不良反应发生情况。结果 42例中36例（85.7%）痊愈,治愈时间为12~30 d,平均（19.3±4.9）d,5例经手术治愈,1例最终摘除眼球。1例患者在第5次注射后突然出现眼部刺激症状,给予双氯酚酸钠滴眼液点眼,2d后症状消失。所有病例随访1~3个月,无穿刺道瘢痕形成,治愈者无复发。结论对常规治疗无效的真菌性角膜炎患者采用角膜基质内注射氟康唑联合匹马霉素滴眼液点眼可取得良好的治疗效果。     

真菌性角膜溃疡继发真菌性眼内炎的治疗

目的 研究真菌性角膜溃疡继发真菌性眼内炎的有效治疗方法.方法 真菌性角膜溃疡继发真菌性眼内炎4例.入院后使用抗真菌药物静脉滴注及滴眼,或联合伏立康唑玻璃体腔注药(100μg/0.1 ml),效果不佳,于平均72 h内行穿透性角膜移植术联合临时人工角膜下玻璃体切除或硅油取出术,术中及术后行1次或多次伏立康唑玻璃体腔内注射.术后使用伏立康唑静脉滴注和/或滴眼,其中1例联合伏立康唑结膜下注射.结果 4例均成功治愈了角膜及眼内真菌感染,最佳矫正视力分别由术前手动/10 cm、光感、光感、手动/50 cm提高至术后0.8、手动/30 cm、0.05、0.2.除1例中央甘油植片不透明者外,其余患眼均获得有用视力.随访7～9个月,感染未复发.2例接受活性保存的角膜植片者随访中均未发生免疫排斥.结论 临时人工角膜下眼前后段联合手术是治疗真菌性角膜溃疡继发真菌性眼内炎的有效手术方案,以伏立康唑多途径给药治疗该病获得了良好效果.     

角膜基质内注射氟康唑治疗真菌性角膜炎的疗效观察

目的探索角膜基质内注射氟康唑治疗真菌性角膜炎的临床疗效及安全性。方法对明确真菌性角膜炎的病例进行筛选,洗眼消毒后,病变区角膜基质内注射氟康唑注射液,观察疗效并隔日注射。结果本组患者32例进行角膜基质内注射氟康唑注射液,联合抗真菌滴眼液及全身药物治疗,痊愈27例,无效5例联合手术治疗,无一例治疗失败,痊愈率84.4%。结论角膜基质内注射氟康唑注射液是治疗和控制真菌性角膜炎安全有效的新的给药途径,对治疗合并真菌性眼内炎的病例的有效性尚待研究实践。     

角膜基质内注射氟康唑治疗真菌性角膜炎的疗效观察

目的:探索角膜基质内注射氟康唑治疗真菌性角膜炎的临床疗效及安全性。方法:对明确真菌性角膜炎的病例进行筛选,洗眼消毒后,病变区角膜基质内注射氟康唑注射液,观察疗效并隔日注射。结果:本组患者58例进行角膜基质内注射氟康唑注射液,联合抗真菌滴眼液及全身药物治疗,痊愈47例,无效11例联合手术治疗,痊愈率81%。结论:氟康唑注射液角膜基质内注射对治疗和控制真菌性角膜炎是安全有效的     

伏立康唑治疗浅中层真菌性角膜溃疡的疗效观察

目的：观察局部应用伏立康唑治疗浅中层真菌性角膜溃疡的临床效果。方法回顾性分析2012年7月至2013年11月间于山东省眼科医院诊治的59例（59只眼）溃疡直径在2～6 mm,经氟康唑治疗效果欠佳,改用伏立康唑治疗的浅中层真菌性角膜溃疡患者资料,分析其临床特征、治疗方法及愈后,观察伏立康唑在治疗浅中层真菌性角膜溃疡的临床效果。结果59例患者中经伏立康唑药物治愈的患者22例（37．29％）,主要是溃疡直径在（3．800±1．196） mm,溃疡浸润深度/角膜厚度为0．292±0．111的真菌性角膜溃疡患者可通过单纯伏立康唑药物治疗得到较佳的治疗效果。结论对于部分浅中层真菌性角膜溃疡患者,在临床应用氟康唑效果欠佳的情况下可通过应用伏立康唑治疗,对30％以上的患者仍能得到较佳治疗效果。     

角膜损伤后真菌性角膜炎的治疗

目的探讨角膜损伤后真菌性角膜炎的临床治疗效果。方法对临床上确诊的真菌性角膜炎21例（21眼）先用药物（伊曲康唑联合氟康唑）治疗，对药物治疗效果差者尽早联合结膜瓣遮盖术。术后随访3～12月，平均6，5月。结果21例中10例（47．62％）单用药物治疗溃疡愈合。另有11例（52．38％）接受了结膜瓣遮盖术，其中9例溃疡愈合，另2例角膜穿孔瘢痕愈合。结论伊曲康唑联合氟康唑治疗真菌性角膜溃疡是一种较为安全有效的药物，对药物反应不敏感者尽早联合结膜瓣遮盖术。可明显提高治愈率。     

角膜基质内注射不同浓度氟康唑治疗真菌性角膜炎的疗效观察

背景 真菌性角膜炎是严重危害视功能的角膜感染性疾病,其治疗较为棘手.近年来角膜基质内注射抗真菌药物不仅丰富了该病的治疗手段,而且取得了较好的临床效果,正确地选择用药种类和适当的药物浓度不仅可提高真菌性角膜炎的治愈率,还可减少注射后的不良反应,但这方面的研究报道相对较少.目的 观察角膜基质内注射不同浓度氟康唑治疗真菌性角膜炎的疗效. 方法 采用前瞻性病例对照研究,纳入2012年5月至2015年1月在冀中能源邢台矿业集团总医院诊治的102例102眼真菌性角膜炎患者,根据完全随机方法分为3个组,其中点眼治疗组(29眼)给予质量分数0.5％氟康唑和质量分数5％那他霉素滴眼液点眼,0.1％氟康唑组(35眼)和0.2％氟康唑组(38眼)在点眼治疗组治疗基础上再分别给予0.1％和0.2％氟康唑角膜基质内注射.各组患者均行KOH湿片检查和真菌培养,观察各组疗效及不良反应情况.结果 病原菌检测排在前3位的致病菌种分别是镰刀菌41.2％ (42/102)、曲霉菌21.6％(22/102)和链格孢菌17.6％(18/102),各组患者致病菌总体比较差异无统计学意义(x2=3.763,P＞0.05).点眼治疗组的治愈率为44.8％(13/29),明显低于0.1％氟康唑组的74.3％(26/35)和0.2％氟康唑组的81.6％ (31/38),差异均有统计学意义(x2=5.782、9.854,均P＜0.05);0.1％氟康唑组与0.2％氟康唑组治愈率比较差异无统计学意义(x2 =0.566,P＞0.05).点眼治疗组、0.1％氟康唑组和0.2％氟康唑组的平均治愈时间分别为(36.28±10.39)、(29.14±7.86)和(21.34±8.57)d,各组平均治愈时间总体比较,差异有统计学意义(F=5.336,P=0.006).0.1％氟康唑组和0.2％氟康唑组患者治疗后视力较治疗前均有提高,差异均有统计学意义(t=3.009、4.695,均P＜0.01),但点眼治疗组治疗前后视力比较差异无统计学意义(t=1.364,P＞0.05).0.1％氟康唑组的平均注射次数为(5.71±2.97)次,显著高于0.2％氟康唑组的(5.13±1.80)次,两组比较差异有统计学意义(t=4.471,P＜0.05).0.2％氟康唑组有4例注射后出现了较明显的眼部刺激症状,给予双氯酚酸钠滴眼液点眼2d后,3例症状消失,1例症状持续1周不缓解,且角膜感染渐加重,最终经结膜瓣遮盖治疗后痊愈.所有患者随访1～3个月未见不良反应及复发. 结论 角膜基质内注射氟康唑是治疗真菌性角膜炎的有效方法.为减少注射后不良反应,对轻型真菌性角膜炎患者建议首选0.1％氟康唑作为角膜基质内注射用药,中型、重型真菌性角膜炎患者及对0.1％氟康唑角膜基质内注射疗效不佳者可考虑0.2％氟康唑角膜基质内注射.     

真菌性角膜炎的早期诊断与治疗

目的 探讨真菌性角膜炎(FX)的早期诊断与治疗方法.方法 对25例(25只眼)角膜炎患者结合病史,首诊采用经济快捷、可反复操作的氢氧化钾湿片法检查,并同时傲真菌培养及药敏.将临床确诊为FK的25例轻症患者进行局部清创、碘酊烧灼、病变区角膜基质内注射氟康唑,0.5%氟康唑点眼15 min 1次,口服伊曲康唑0.2/日.根据病情可隔日注射和调整用药种类、数量和给药方法.结果 25只眼中,24只眼痊愈;1只眼3次注射后无效而联合手术治疗痊愈.结论 FK的首诊湿片法检查是FK明确诊断的捷径,尽可能地提高初次诊断的正确率至关重要.清创、碘酊烧灼、病变区角膜基质内注射等抗真菌药物的联合应用,可使绝大多数早期轻症FK患者达到临床治愈.     

清创及生物羊膜移植联合药物治疗真菌性角膜炎

目的 探讨角膜清创联合生物羊膜移植并术后抗真菌药物治疗真菌性角膜炎的效果.方法 真菌性角膜炎39例（39眼）,采用角膜清创联合生物羊膜移植术,术后结膜下注射抗真菌药物及局部抗真菌滴眼液滴眼.随访3～6月,裂隙灯显微镜观察生物羊膜愈合情况、角膜溃疡情况、视力提高情况.结果 36例角膜溃疡愈合,3例因羊膜脱落,再次行生物羊膜移植术,术后继续局部治疗,溃疡愈合良好.结论 角膜清创联合生物羊膜移植并术后抗真菌药物结膜下注射是一种行之有效的治疗真菌性角膜炎方法.     

非典型单纯疱疹性盘状角膜炎诊治38例分析

目的 探讨非典型单纯疱疹性盘状角膜炎的临床特点及治疗。方法 对38例（47只眼）诊断为疱疹性角膜炎患者单纯使用抗病毒药物较长时间治疗无效者,在抗病毒药物基础上应用皮质激素眼液滴眼观察。结果 患者经治疗后,短期内症状明显好转,视力迅速提高,角膜基质炎症明显减轻,荧光染色检查角膜上皮损害进行性好转、愈合。结论 对诊断为疱疹性角膜炎而单纯使用抗病毒药物较长时间治疗无效,角膜基质炎变明显而又无典型盘状角膜炎表现患者,在抗病毒药物基础上应用皮质激素眼液滴眼治疗效果明显,角膜病变逐渐好转,应考虑为非典型表现性盘状角膜炎。     

The Effect of a Comprehensive Treatment Regimen for Deep Stromal Fungal Keratitis

Objective: To evaluate the efficacy and safety of a comprehensive treatment regimen based on intrastromal voriconazole injection in the treatment of deep stromal fungal keratitis in which the lesion has infiltrated more than half of the corneal stroma. Methods: This was a retrospective study. Sixty-two patients (62 eyes) with deep stromal fungal keratitis who underwent intrastromal voriconazole injection were selected at the Eye Hospital, Wenzhou Medical University from March 2013 to July 2017. Age, the diameter of the ulcer, cure rate, recurrence rate, complications, etc., were measured. All the patients were followed up for at least 6 months. Sixty-two patients were divided into an effective group (EGII) and an ineffectivegroup (IGII) based on the effect of the pure intrastromal voriconazole injection. The data were analyzed by an independent samples t-test and Chi-square test. Results: The 62 patients had ulcer diameters ranging from 2.8 to 11.0 (5.5±2.1)mm. The time from onset to treatment for the 62 patients ranged from 2 days to 2 years (44.2±98.6)days. Six patients sought treatment more than half a year after onset, and the remaining 56 patients had an onset time of 21.2±13.6 days. All patients were followed up for 6 to 36 (10.5±7.5)months. Forty-two patients (42 eyes) were cured by pure intrastromal voriconazole injection, 1 patient (1 eye) underwent a corneal transplant to improve vision after intrastromal voriconazole injection was effective; 19 patients (19 eyes) underwent conjunctival flap coverage after the injection failed. Combined with conjunctival flap coverage, 11 eyes were cured, 8 eyes required corneal transplants, and 2 patients relapsed after corneal transplants. The cure rate of the comprehensive treatment regimen was 85.5%, and the recurrence rate was 3.2%. The EGII group had a smaller ulcer diameter than the IGII group, and the difference between the two groups was statistically significant (t=-2.199, P=0.032). There were no complications during or after the operation. Conclusions: Intrastromal voriconazole injection has a safe and beneficial effect on deep stromal fungal keratitis that does not respond to conventional drugs. For eyes with a wide range of lesions, the effect of pure intrastromal voriconazole injection was not good, but the cure rate can be improved when treatment is combined with conjunctival flap coverage.     

羊膜移植与结膜瓣遮盖在角膜溃疡治疗中临床疗效的对比观察

目的:分析羊膜移植与结膜瓣遮盖在角膜溃疡治疗中的临床疗效,探讨其在角膜溃疡治疗中的不同手术适应范围,为临床治疗提供循证医学依据。方法:回顾性分析我院2004-10/2009-07行羊膜移植或结膜瓣遮盖手术治疗的角膜溃疡住院患者46例47眼,其中病毒性角膜溃疡13例14眼,真菌性角膜溃疡19例19眼,细菌性角膜溃疡7例7眼,蚕食及边缘性角膜溃疡3例3眼,无菌炎症性角膜溃疡2例2眼,手术引起角膜内皮失代偿致角膜上皮大泡、溃疡2例2眼;穿孔9例9眼。上述患者行病灶清除+羊膜移植或结膜瓣遮盖手术治疗,行羊膜移植17例18眼,结膜瓣遮盖29例29眼,其中结膜瓣遮盖后行角膜移植2例2眼,术后针对原发病进一步进行药物治疗。结果:羊膜移植治疗后,治愈13例14眼,治愈率为78%(14/18);行结膜瓣遮盖治疗后,治愈23例23眼,治愈率为79%(23/29);二者在临床治愈率上没有明显的差别(P>0.05)。结论:羊膜移植与结膜瓣遮盖根据不同的溃疡类型及不同的溃疡发展进程选择合适的手术方式可以达到较好的手术疗效。     

自体结膜瓣覆盖术治疗深层角膜溃疡

目的：评价自体结膜瓣覆盖术对深层角膜溃疡的治疗效果。

方法：分析于2010-05/2011-10在中国医科大学眼科中心行自体结膜瓣覆盖术的14例深层角膜溃疡患者的预后。14例患者中包括6例病毒性角膜炎患者,7例真菌性角膜炎患者和1例细菌性角膜炎患者。进行结膜瓣遮盖术前,真菌性角膜炎患者用氟康唑冲洗角膜溃疡,细菌和病毒性角膜炎患者用庆大霉素液体冲洗角膜溃疡。根据角膜溃疡大小不同采取部分或全部结膜瓣覆盖术。术后根据不同的角膜炎类型使用不同的抗菌素共4wk。所有的患者术后均随访观察结膜瓣存活情况、并发症及视力恢复情况,随访时间达10～18mo。

结果：所有患者经历1次手术后均痊愈(治愈率为100%)。除1例结膜瓣脱落外,其余患者术后2wk自体结膜瓣均存活并与角膜溃疡处贴附紧密(85.71%)。这13例患者的结膜瓣在随访观察期间内逐渐变得透明并发生了不同程度的退缩。1例真菌性角膜炎患者在术后3mo时角膜炎复发,在使用那他霉素眼液点眼3wk后痊愈。1例患者术后3mo时并发浅前房。1例患者术后10mo并发后弹力层膨出。1例患者术后1a并发了青光眼。所有的患者成功地保留了眼球,但视力提高不明显。

结论：自体结膜瓣覆盖术治疗深层角膜溃疡有效,但是术后长期观察存在一定的并发症。     

Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis

PURPOSE: To evaluate the role of intrastromal injection of voriconazole in the management of deep recalcitrant fungal keratitis. DESIGN: Interventional case series. METHODS: Setting: Cornea services at a tertiary care teaching hospital. Patients: Three eyes of three patients with deep stromal recalcitrant fungal keratitis not responding to topical antifungal medications. Intervention Procedure: Voriconazole 50 micrograms/0.1 ml was injected circumferentially around the fungal abscess in the corneal stroma as an adjunctive to the topical antifungal therapy. Main Outcome Measure: Main outcome measure was a reduction in size of the abscess and resolution of the infection. RESULTS: Before the intracorneal injection, all three eyes had gradually worsening lesions on topical medications. After the intervention, a faster reduction in the size of corneal infiltration was documented and a complete resolution of the ulcers was seen within three weeks in all cases. CONCLUSION: Targeted delivery of voriconazole by intracorneal injection may be a safe and effective way to treat cases of deep-seated recalcitrant fungal keratitis responding poorly to conventional treatment modalities.     

Clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis

AIM: To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis. METHODS：A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae.Local and systemic antifungal therapy more than one week for all patients, corneal ulcer enlarge or no shrink.Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm.Anterior segment optical coherence tomography（AS-OCT）examine the depth of corneal ulcer between 1/3-1/2,infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis. Complete removal lesions until transparent of stroma, make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva. Continued antifungal therapy. The vision, fungal recurrence, conjunctival flap rollback or desquamate were analysed. RESULTS：Ten patients had success done this surgery, the corneal ulcer was not enlarge and healing afteroperation.7 cases were bridging conjunctival flap and 3cases were single conjunctival flap. Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery, while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap, no conjunctival flap desquamate. CONCLUSION：It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.     

真菌及阿米巴混合感染性角膜炎临床分析

目的 探讨真菌及棘阿米巴混合感染性角膜炎的发病、临床特征、诊断及其治疗.方法 对2007年7月至2008年12月在福建医科大学附属第一医院确诊的19例真菌及棘阿米巴混合感染性角膜炎进行回顾性临床分析,分析其发病诱因、诊断方法及临床特征,采用抗真菌及阿米巴药物或结膜瓣遮盖术或穿透性角膜移植术进行治疗并观察疗效.结果 19例确诊病例中,14例发病与角膜外伤有关,3例与角膜接触镜相关;所有病例通过角膜刮片镜检,或真菌与阿米巴培养确诊;16例表现为角膜局部溃疡型,3例表现为基质环形浸润;5例经药物治愈,11例经结膜瓣遮盖治愈,2例行穿透性角膜移植术(PKP).结论 真菌及棘阿米巴混合感染性角膜炎的发病诱因以角膜外伤为主,角膜刮片镜检是早期诊断的有效方法,综合药物和手术治疗对感染的控制具有重要意义.     

Successful treatment of Fusarium keratitis after photo refractive keratectomy

A 39-year-old woman presented to our hospital with a history of photorefractive keratectomy (PRK), performed two weeks prior; slit-lamp examination revealed diffuse conjunctival congestion, corneal ulcer and stromal infiltration. After 5 days of antifungal and antibacteric treatment, the infiltrate progressively increased so that a therapeutic penetrating keratoplasty was necessary. The microbiological analyses revealed the presence of fungal filaments. Twenty days after surgery the patient had recurrent fungal infiltrate in the donor cornea with wound dehiscence. We performed a second penetrating keratoplasty. With the matrix-assisted-laser-desorption-ionization-time-of-flight analysis (MALDI-TOF) we identified a Fusarium solani. Intravenous amphothericine B, a combination of intracameral and intrastromal voriconazole and intracameral amphotericine B were administered. After 6 months from the last surgery the infection was eradicated. The management of fungal keratitis after PRK depends on many factors: In our experience, a prompt keratoplasty and the use of intracameral antifungal medication proved to be very effective.     

清创术加结膜瓣遮盖治疗真菌性角膜溃疡

目的 观察病灶清创术加结膜瓣遮盖对不同程度的真菌性角膜溃疡的治疗效果.方法 回顾26例（26眼）病灶清创术加结膜瓣遮盖治疗的真菌性角膜溃疡愈合情况.结果 15例早期者全部一次手术治愈,11例前房积脓者6例复发.结论 病灶清创术加结膜瓣遮盖对早期真菌性角膜溃疡治疗效果良好.     

伏立康唑治疗中重度真菌性角膜溃疡的初步观察

目的 观察伏立康唑全身及眼部用药治疗中、重度真菌性角膜溃疡的临床效果.方法 回顾分析24例(24只眼)真菌性角膜溃疡患者的治疗经过和结果.其中中度角膜溃疡17例、重度7例.所有患者均用伏立康唑静脉滴注,首次6mg/kg,次日4mg/kg,均为12h1次;1%伏立康唑眼液点眼,每1h1次;前房积脓冲洗联合伏立康唑前房注药;局部清创,每1～2日1次,最后根据病情选择自体改良结膜瓣遮盖术、治疗性角膜移植手术等.结果 24只眼中有21只眼(87.5%)达到临床治愈,1只眼好转,2只眼无效.无效的2只眼中有1例行眼内容剜除术,1例行角膜移植手术.未出现严重药物不良反应.结论 伏立康唑是有效、安全的治疗真菌性角膜溃疡的药物,值得临床推广应用.

Abstract：

Objective To investigate the effect of voriconazole in the systemic and local medication treatment of moderate and severe fungal corneal ulcers.Methods The treatments and results of 24 patients (24 eyes)with fungal corneal ulcers were retrospective analyzed.Of 17 cases were with moderate corneal ulcers and 7 with severe corneal ulcers.All patients were treated with intravenous voriconazole,6mg/kg for the first time,4 mg/kg on day 2,once per 12 hours; 1% of the voriconazole eye drops,once per 1 hour; hypopyon was washed out with anterior chamber injection of voriconazole,with local debridement,once per 1 to 2 days.Finally,the conjunctival flap covering surgery or the corneal transplant surgery was chosen based on the condition of patients.Results In 21 of 24 eyes(87.5%)achieved clinical cure,one eye improved and two invalid;1 of the 2 invalid eyes received eye evisceration surgery,the other received a corneal transplant surgery,with no serious adverse drug reactions.Conclusions Voriconazole is a safe,effective medicine in treating fungal corneal ulcers,and it is worthy of clinical application.     

临时结膜瓣对真菌性角膜溃疡愈合及新生血管形成影响的研究

目的观察临时结膜瓣对真菌性角膜溃疡愈合和角膜新生血管形成的影响。方法采用随机对照的方法,将真菌性角膜溃疡86例（86眼）分为两组。A组：临时结膜瓣移植组,51例;B组：常规结膜瓣移植组,35例。观察并比较A、B两组的治愈率、治愈时间及角膜新生血管形成率。随访6个月。结果两组间治愈率差异及治愈时间差异均无统计学意义（P〉0.05）,角膜新生血管形成率两组间差异有统计学意义,A组角膜新生血管形成率明显低于B组（P〈0.01）。结论临时结膜瓣能促进真菌性角膜溃疡愈合,并能减少角膜新生血管形成,其疗效优于常规结膜瓣。