角膜基质层间注射两性霉素B治疗难治性真菌性角膜溃疡的临床观察

Clinical effectiveness of intrastromal amphotericin B injection for refractory fungal keratohelcosis

目的初步评价角膜基质层间注射两性霉素B治疗难治性真菌性角膜溃疡的效果,探索真菌性角膜溃疡局部治疗的新方法。方法诊断为真菌性角膜溃疡的6例患者(6只眼),男性3例,女性3例,年龄32～68(46.0±13.6)岁,在抗真菌滴眼液治疗2周或以上效果不明显者,采用30 G针头予以7.5μg/0.1 ml两性霉素B 0.1 ml围绕角膜溃疡周围透明角膜的基质层内注射,每隔3天1次,继续辅以那他霉素滴眼液等抗真菌治疗,随访观察患者术后病情变化。结果6例患者接受角膜基质层间注射两性霉素B治疗的病程平均为9.8周,手术前视力从手动/眼前至0.1,每例患者经3～5次角膜基质层间注射两性霉素B治疗后,4例患者的视力明显提高,另2例患者视力稳定,随访时最佳视力从CF/10 cm～0.4,患者的角膜溃疡均愈合,遗留部分角膜白斑或云翳,平均随访半年无严重手术并发症发生。结论角膜基质层间注射两性霉素B是一种有效、安全的治疗真菌性角膜溃疡的方法。

Objective To evaluate the therapeutic effectiveness of intrastromal amphotericin B （AmB） injection in the treatment of refractory fungal keratohelcosis in order to explore a new way for topical treatment. Methods A total of 6 eyes from 6 patients who were diagnosed as fungal keratohelcosis and had no obvious response to a over-2-week treatment of topical antifungal eye-drops were enrolled in the study. They were given intrastromal injection of AmB （7.5 μg in 0.1 ml） at the periphery clear cornea with a 30-gauge patented corneal stroma injection needle, once every 3 d, and were also treated with topical antifungal eye- drops. The clinical efficacy and outcomes were assessed after the treatment and during follow-up. Results Six patients included 3 males and 3 females, with a mean age of 46.0 ± 13.6, and their mean course of disease was 9.8 weeks. Before the intrastromal injection, their best-corrected visual acuity （BCVA） ranged from hand movement （HM） to 0.1. After giving 3 to 5 times of intrastromal injections for each patient, VA of 4 patients was increased greatly, and that of the other 2 maintained the same. The BCVA reached from CF/10cm to 0.4. All eyes healed with corneal scar formation, and no serious complication occurred during the 6 months＇ follow-ups. Conclusion Intrastromal injection of AmB is an effective and safe way for refractory fungal keratohelcosis.