真菌性角膜炎的早期诊断与治疗

The early diagnosis and treatment of the fungal keratitis

目的探讨真菌性角膜炎(FK)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,并同时做真菌培养及药敏。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。

Objective Discussing the early diagnosis, treatment and the importance of the ftmgal keratitis （FK）. Methods FK was diagnosed firstly according to the medical record. The clinical diagnosis was to adopt potassa wet fdm screening method which was economical, fast, repeated operational, and to do the fungal plant and the test of drug sensitivity at the same time. Then doing the partial debridement, iodine for external use, injection of fluconazole in the corneal stroma of disease area through the 25 patients with mild disease whom were clinical diagnosed with FK. 0.5% fluconazole eye drops were used？ every 15 minutes,Itraconazole 0.2 po. qd, injecting drug on alternate days and adjustment of the medical variety, quantity and delivery according to the state of the illness. Results 24 patients were cured in the 25 patients ; the last person was recovered finally with the occasional joint surgery after three times ineffective treatment. Conclusion The initial diagnosis with wet film screening method was a shortcut in the treatment of the FK. Improving the accuracy of initial diagnosis possibly was very important. With the combined usage of the partial debridement, the usage of iodine and the antifungal injection in the corneal disease will enable the majority of the patients in the early FK with mild disease to reach clinical cure.