深基质真菌性角膜炎综合治疗方案的疗效评估

目的：探讨基于角膜基质内注射伏立康唑的综合治疗方案对感染灶浸润深度达1/2角膜基质以上的 深基质真菌性角膜炎的有效性和安全性。方法：回顾性临床研究。选择2013年3月至2017年7月 于温州医科大学附属眼视光医院行角膜基质内注射伏立康唑治疗的深基质真菌性角膜炎患者62例 （62眼）的资料进行分析。观察指标包括年龄、溃疡直径、治愈率、复发率以及并发症情况等，注射 术后至少随访6个月；并根据角膜基质内注药效果将患者分为单纯角膜基质内注药有效组和单纯角 膜基质内注药无效组。采用独立样本t检验及卡方检验对数据进行统计分析。结果：62例患者的溃 疡直径为2.8～11.0（5.5±2.1）mm，患者发病到就诊时间为2 d～2年（44.2±98.6）d，其中6例患者主 诉病史超半年，56例患者发病到就诊时间为（21.2±13.6）d；术后随访6～36（10.5±7.5）个月。单纯 角膜基质内注射伏立康唑治愈42例（42眼）；1例（1眼）患者角膜基质注药有效后为提高视力行角膜移 植；单纯角膜基质内注射伏立康唑无效19例（19眼），联合行结膜瓣覆盖治疗后，治愈11眼，需再行 角膜移植8眼，其中2眼术后复发。该综合治疗方案治愈率为85.5%，复发率为3.2%。单纯角膜基质 内注药有效组溃疡直径小于单纯角膜基质内注药无效组，差异有统计学意义（t=-2.199，P=0.032）。 术中及术后随访均未见并发症。结论：角膜基质内注射伏立康唑对常规药物治疗无效的深基质真菌 性角膜炎有良好的疗效并且安全性较高。而对于病灶范围广泛的患眼，单纯角膜基质内注药疗效欠 佳，联合结膜瓣覆盖治疗可提高治愈率。

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.