角膜溃疡清创联合抗真菌治疗真菌性角膜炎

The Corneal Ulcer Debridement Combined with Anti-fungal Therapy in Treatment of Fungal Keratitis

目的探讨角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎的效果。方法收集2011年6月—2012年6月真菌性角膜炎40例,对患者进行角膜刮片检查并施行角膜溃疡清创术,术后局部频繁应用0.5%氟康唑及5%那他霉素滴眼液,口服伊曲康唑等抗真菌药物治疗,清创术治疗无效者采用板层角膜移植术或穿透性角膜移植术治疗,观察治疗效果。结果角膜刮片阳性结果36例,阳性率90%,3例于外院行共焦显微镜检查菌丝阳性;1例为明确植物外伤史的6岁男童,不配合真菌检查。40例真菌性角膜炎全部治愈:33例行角膜溃疡清创术联合抗真菌药物治疗痊愈,7例感染不能控制,根据浸润深度行穿透性角膜移植术或板层角膜移植术后治愈,随访均无复发。术前视力0.4～0.6者8例,术后视力无明显变化;术前视力指数(FC)/眼前～0.4者22例,溃疡修复后视力为0.3～0.6;术前视力手动(HM)/眼前～FC/眼前者10例,溃疡修复后视力为HM/眼前～0.3。结论角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎是一种有效、经济、可行的治疗方式。

Objective To explore the effect of corneal ulcer debridement combined with anti-fungal agents in treatment of fungal keratitis. Methods A total of 40 patients with fungal keratitis during June 2011 and June 2012 underwent collaeal scraping and corneal ulcer debfidement, frequently using 0.5% fluconazole and 5% Natamycin eye drops in part and itraconazole orally. Patients with ineffective treatment underwent the lameUar keratoplasty or penetrating keratoplasty. The treatment effectiveness was observed. Results There were 36 patients with positive result of corneal scraping and positive rate was 90%, 3 patients with positive hyphae by confocal microscopy in other hospitals and a 6-year-old boy with planting history of trauma who refused to cooperate in the fungi examination. All the 40 patients with fungal corneal ulcer were cured： 33 patients with corneal ulcer debridement combined with antifungal treatment, 7 patients with infection who could not be controlled with penetrating keratoplasty or [amellar keratoplasty according to the depth of invasion, and there was no recurrence in fol- low-ups. Eight patients had preoperative visual acuity of 0. 4 -0.6, there were no significant changes in visual acuity after operation; twentytwo patients had preoperative visual acuity fingers counting （FC）/antocular - 0. 4, visual acuity of 0. 3 - 0. 6 after ulcer repair; ten patients＂ preoperative vision for hand movement （HM）/antocular -FC/Frant had vision HM/antocular -0. 3 after ulcer repair. Conclusion The method of corneal ulceration debridement combined with antimycotic drug is effective, low-cost and feasible in treatment of fungal keratitis.