眼局部应用两性霉素B脂质体治疗外伤后真菌性角膜溃疡

Efficacy of topical amphotericin B treatment in the management of refractory traumatic keratomycosis

目的观察眼局部应用两性霉素B脂质体治疗氟康唑无效的外伤后真菌性角膜溃疡的临床疗效。方法选择外伤后经角膜共焦显微镜及实验室检测确诊为真菌性角膜溃疡(溃疡直径≤5mm)27例(27眼)。其中角膜溃疡13例,角膜溃疡并前房积脓14例。在应用氟康唑治疗无效后应用两性霉素B脂质体滴眼以及前房注药治疗,同时进行常规溃疡面清创、碘酊烧灼治疗,观察其疗效。结果27眼中有22眼达到临床治愈,视力均较术前提高,5眼无效。此5眼中角膜溃疡中有1眼中途放弃治疗,1眼角膜穿孔后行角膜移植;前房积脓者中,1眼中途放弃、1眼行角膜移植;1眼行眼内容物摘除术。结论在早期快速诊断前提下,眼局部使用两性霉素B脂质体是目前治疗外伤后重症真菌性角膜溃疡有效方法之一。

Objective To evaluate the efficacy of amphoteriein B topical injection in the management of traumatic keratomycosis after ocular trauma which not responding to conventional antifungal therapy. Methods Records of 27 patients who were clinical diagnosed with fungal keratitis from November, 2005 to June, 2007 were retrospectively reviewed. All patients didnot respond to initial treatment with topical and intravenous fluconazole, All patients were treated with amphotericin B and topical treatment. Results Among 27 eyes visual acuity was improved in 22 eyes, 5 eyes did not respond include 2 eyes with keratomycosis give up treatment, 3 eyes with hypopyon, and endophthalmitis need surgical treatment. Conclusion Topical amphotericin B treatment with correct early diagnosis may be an effective adjunctive treatment of traumatic fungal keratatis unresponsive to conventional antifungal therapy.