真菌性角膜溃疡继发真菌性眼内炎的治疗

Treatment for fungal endophthalmitis resulting from fungal keratitis

目的研究真菌性角膜溃疡继发真菌性眼内炎的有效治疗方法。方法真菌性角膜溃疡继发真菌性眼内炎4例。入院后使用抗真菌药物静脉滴注及滴眼，或联合伏立康唑玻璃体腔注药（100μg／0．1ml），效果不佳，于平均72h内行穿透性角膜移植术联合临时人工角膜下玻璃体切除或硅油取出术，术中及术后行1次或多次伏立康唑玻璃体腔内注射。术后使用伏立康唑静脉滴注和／或滴眼，其中1例联合伏立康唑结膜下注射。结果4例均成功治愈了角膜及眼内真菌感染，最佳矫正视力分别由术前手动／10cm、光感、光感、手动／50em提高至术后0．8、手动／30cm、0．05、0．2。除1例中央甘油植片不透明者外，其余患眼均获得有用视力。随访7～9个月，感染未复发。2例接受活性保存的角膜植片者随访中均未发生免疫排斥。结论临时人工角膜下眼前后段联合手术是治疗真菌性角膜溃疡继发真菌性眼内炎的有效手术方案，以伏立康唑多途径给药治疗该病获得了良好效果。

Objective To explore treatment methods for fungal endophthalmitis resulting from fun- gal keratitis. Methods 4 eases diagnosed as fungal endophthalmitis resulting from fungal keratitis were ob- served. All patients were firstly treated with topical and intravenous antifungal drugs or combination with vori- conazole intravitreous injection （ 100 μg/0.1 ml） after admission to hospital. Then operation of penetrating keratoplasty combined with vitrectomy or silicone oil removal under temporary artificial cornea was performed within about 72 hours for progression of the disease. Intravitreous injection of voriconazole was given ortce or more intra-and postoperatively. Intravenous and/or topical voriconazole was given postoperatively. One case also received subconjunctival injection of voriconazole. Results All cases got resolution of fungal infection with BCVA improved from HM/10 cm, LP, LP and HM/50 cm to 0.8, HM/30 era, 0.05 and 0.2 respec- tively. All cases got useful VA except the one with opaque glycerin - eryopreserved graft put in the center. Within 7 - 9 months＇ follow-up, no recurrent case was observed and the 2 cases with fresh grafts had no im- mune rejection. Conclusion Combined operation of anterior and posterior segments under temporary artifi- cial cornea and voriconazole delivery in varied pathways were proved to be effective treatment methods for fungal endophthalmitis resulting from keratitis.