角膜基质内注射脂质体性两性霉素B治疗真菌性角膜炎的初步临床观察

Intracorneal Injection of Liposomal Amphothericin B for Fungal Keratitis

目的：观察角膜基质内注射脂质体性两性霉素B治疗真菌性角膜炎的临床效果。方法：选择我院诊断为真菌性角膜炎并常规抗真菌治疗2周无效的患者12例（12眼）。于病灶处角膜基质内注射两性霉素B脂质体10μg（0.05 ml）。术后继续使用局部、全身药物治疗,观察术前、术后角膜情况、前房反应以及晶状体情况。根据病情可于1周后重复注射。结果：6例患者1次注射后1周内病灶明显缩小,均于辅助局部药物治疗后1个月内病灶痊愈;其余6例患者1周后行2次注射,有3例患者病灶缩小,于辅助局部药物治疗后1个月内病灶痊愈,3例患者2次注射后病情仍发展,其中2例行板层角膜移植术,1例行穿透性角膜移植术,均有效控制感染。术后随访3~6个月,未发现角膜内皮损伤、虹膜萎缩及继发青光眼。结论：角膜基质内注射脂质体性两性霉素B可作为辅助手段治疗难治性真菌性角膜炎,有一定的临床效果,治疗安全,短期观察无明显并发症。

Objective： To evaluate the clinical efficacy of intracorneal injection of liposomal Amphothericin B on the management of fungal keratitis. Methods： A total of 12 eyes of 12 patients with stromal recalcitrant fungal keratitis were not responding to topical antifungal medications. Liposomal Amphothericin B 10 μg（ 0. 05 ml） was injected into the local stroma as an adjunctive to the topical antifungal therapy. Corneal conditions of preoperative and postoperative,anterior chamber reaction,and the lens’ conditions were observed. According to the reaction,repeated injection could be performed after 1 week. Results： After the first intracorneal injection,the corneal infiltration reduced fast and the ulcer completely healed within 1 week in 6 patients. The other 6 patients were performed repeated injection after 1 week,the ulcer completely healed within 1 month after the second injection in 3 patients,but there were no responds in 3 patients. Deep anterior lamellar keratoplasty（ DALK） was performed in 2 patients,penetrating keratoplasty（ PKP） was performed in 1 patient,infection was controlled successfully in all patients. Postoperative follow-up 3 to 6 months,corneal endothelial damage,iris atrophy and secondary glaucoma were not observed in all patients. Conclusions： Intracorneal injection of liposomal Amphothericin B is safe,effective and can be used as an adjunct treatment for fungal keratitis.