0.2%氟康唑注射液前房冲洗治疗真菌性角膜炎

Efficacy of 0. 2% fluconazole anterior chamber irrigation as the treatment for fungal keratitis

目的观察0.2%氟康唑注射液前房冲洗术对真菌性角膜炎治愈率的影响,评价0.2%氟康唑注射液前房冲洗治疗真菌性角膜炎的有效性及安全性。方法回顾性分析2012年6月至12月真菌性角膜炎患者22例(22只眼),根据是否采用0.2%氟康唑注射液前房冲洗术分为2组。对患者手术前后眼前节彩色照片、眼前节OCT、共焦激光显微镜、真菌刮片镜检结果等进行分析,以临床治愈率作为指标评价两组间疗效的差异。结果前房冲洗组患者病情比对照组重,表现为溃疡面积大,浸润深,前房积脓多。随访时间2～6个月内前房冲洗组感染控制率为100%(6/6),对照组为75%(12/16)。5只眼行0.2%氟康唑注射液前房冲洗术患者术中发生虹膜表面出血,均在停止操作后自动止血,术后3 d内完全吸收,随访过程中没有发现角膜内皮失代偿等并发症。结论0.2%氟康唑注射液前房冲洗术有助于控制真菌性角膜溃疡的感染,可以作为真菌性角膜炎治疗的有效手段。

Objective To evaluate the efficacy and safety of 0.2% fluconazole anterior chamber irrigation as the treatment for fungal keratitis.Methods The outcomes of twenty-two fungal keratitis patients who were treated in our clinic between June and December 2012 were retrospectively analyzed.Among all 22 cases,six patients received 0.2% fluconazole irrigation.Anterior segment photographies,angerior segment OCT,in vivo confocal microscope,and fungal smear microscopy results of these patients were reviewed and clinical cure rate were compared to those who did not have fluconazole irrigation.Results Initially,keratitis presented more severely in 6 patients who later received fluconazole irrigation.Specifically,these patients had larger corneal ulcer,deeper infiltration,and more amount of hypopyon.After 2 ～ 6 months＇ follow-up,however,the cure rate was 100%（6 /6） among them.In contrast,the cure rate was only 75%（12 /16） in patients who had less severe keratitis but did not receive fluconazole irrigation.Iris bleeding occurred but stopped automatically and completely resolved within 3 days in 5 patients during anterior chamber irrigation.No endothelial dysfunction or other complications were observed within the follow-up period.Conclusion anterior chamber irrigation with 0.2% fluconazole could help to relieve corneal inflammation and facilitate corneal healing.It is an effective treatment for severe funcal keratitis.