真菌性角膜炎治疗性角膜移植术后局部应用FK506的临床评价

Clinical evaluation of topical FK506 in the management of therapeutic keratoplasty for fungal keratitis

目的探讨真菌性角膜炎治疗性角膜移植术后局部应用0.05%FK506替代糖皮质激素在预防移植免疫排斥反应以及真菌复发中的作用。方法经实验室确诊的154例真菌性角膜炎,治疗性角膜移植术后局部应用0.05%FK506滴眼液1年以上,2周内联合局部0.2%氟康唑滴眼液滴眼。记录术后定期复诊时的视力、植片的透明度及并发症。结果随访患者127例(127眼),平均随访时间(14.63±2.41)个月。共分离出15属127株真菌,居于前3位的主要致病菌属依次为镰孢菌属(38.58%)、曲霉菌属(31.50%)和弯孢霉属(16.54%)。127眼中121眼(95.28%)无复发,105眼(82.68%)最终保持植片透明,62眼(48.82%)视力在0.02以上;8眼(6.30%)出现免疫排斥反应;真菌复发6眼(4.72%);继发性青光眼、并发性白内障的发生率分别为8.66%(11眼)和2.36%(3眼)。结论真菌性角膜炎的治疗性角膜移植术后局部应用FK506,可以替代糖皮质激素有效地预防角膜移植排斥反应的发生,抑制真菌复发,避免局部应用糖皮质激素所带来的相关并发症。

Objective To investigate the efficacy of topical 0. 05% FK506 as a substitute for corticosteroids to prevent allografl rejection of therapeutic keratoptasties for fungal keratitis. Methods Prospective, randomized and dissimilar consecutive case series were reviewed. 154 patients determined as fungal keratitis microbiologically underwent therapeutic keratoplasties. All affected eyes were treated with topical 0.05% FKS06 postoperatively as a primary or an adjunctive therapy for the prevention of corneal allograft rejection. The 0. 2% Difucan was topically allied within the first two weeks after operation to suppress fungal growth. The operative eyes were checked at 1 week, 1 month,2,3 and 6 months, 1 year, 2 and 2.5 years respectively. Results 127 eases（ 127 eyes） collected was followed for 14.63±2.41 months. Total 127 species of 15 genuses were isolated from 127 samples of corneal ulcers. Fusarium （38.58%）was the most frequently isolated species, and the next was Aspergillus （ 31.50% ） and then Currularis （ 16.54% ）. Penetrating keratoplasty （PKP） was performed on 59 eyes （46. 46% ） , and lameltar keratoplasly （LKP） on 11 eves （8.66%） and total keratoplasty or/and combining anterior vitrectomy on 57 eyes （44.88%）. 121 eyes （95.28%） were cured without recurrence of fungal infection, and 105 eyes （ 82. 68% ） remained clear graft at the end of follow-up. Sixty-lwo eyes （ 48. 82% ） got the visual acuity above 0. 02. Complications included graft rejection in 8 eyes （6.30%） ,the rec＇urrence of fungal infection in 6 eyes （4.72%） ,secondary glaucoma in l 1 eyes （8.66%） and cataract in 3 eyes （2.36%）. Conclusion Topical O. 05% FKS06 may be a useful adjunct in management of therapeutic keratoplasty for fungal keratitis. It is a safe alternative to topical corticosteroid for the prevention of allograft rejection by minimizing the risk of recurrence of fungal infection.also avoiding the adverse effects of secondary glaucoma and cataract.