板栗刺刺伤所致真菌性角膜炎14例临床分析

The clinical analysis of 14 cases of fungal keratitis caused by Chinese chestnut thorns

目的探讨板栗刺所致真菌性角膜炎患者的溃疡形态、致病菌属及治疗特点。方法回顾性分析2011年9月—2013年12月收治的14例(14眼)板栗刺所致真菌性角膜炎患者的临床资料,根据溃疡形态分上皮型、基质脓肿型、内皮或前房型,真菌培养获取病原学结果,并根据溃疡类型采用那他霉素+氟康唑+伊曲康唑三联抗真菌药物治疗联合溃疡板层清创、两性霉素B角膜基质注射、平衡盐液前房冲洗及两性霉素B前房注射等手术干预措施,观察治疗效果及预后。结果14例患者中10例真菌培养结果阳性,链格霉菌及镰刀霉菌各4例,青霉菌及曲霉菌各1例;溃疡分型:上皮型7例,基质脓肿型2例,内皮或前房型5例;上皮型对三联抗真菌药物治疗敏感,联合溃疡板层清创术治疗后有效率为100%(7/7);基质脓肿型、内皮或前房型对单纯三联抗真菌药物治疗基本无效,联合两性霉素B基质注射或前房冲洗及两性霉素B前房注射后治疗有效率为85.7%(6/7)。14例均未见严重并发症。结论板栗刺所致真菌性角膜炎在溃疡形态上具有多样性,致病菌属以链格霉菌和镰刀霉菌为主,临床上根据溃疡类型采取抗真菌药物治疗联合恰当的手术干预可取得良好的治疗效果。

Objective To explore the features and treatment of ulcer morphological, pathogenic bacteria of fungal keratitis which is caused by chestnut. Methods From 2011 September to 2013 December, retrospective analysis clinical data of 14 cases （ 14 eyes） of fungal keratitis which were caused by chestnut, according to the ulcer morphology, they were classi- fied as epithelial type, matrix abscess type, endothelial or anterior chamber type ; using of fungal culture to obtain etiological results, and according to the type of the ulcer, natamycin ＋ itraconazole ＋ fluconazole antifungal drug therapy combined with ulcer combined lameUar debridement, amphotericin B intrastromal injection, balanced salt solution for irrigation of anterior chamber and amphotericin B anterior chamber injection operation intervention were performed, and observe the therapeutic effect and prognosis. Results Among the 14 patients, 10 cases with fungal culture positive results, Ahernaria fungi and Fu- sarium sp. were found in 4 cases separately, Penicillium and Aspergillus were in 1 case separately; ulcer types： epithelial type in 7 cases, 2 cases of stromal abscess type, 5 cases of endothelial or epithelial type on the anterior chamber; antifungal drug was sensitive for epithelial type, combined with plate layer ulcer debridement treatment, efficiency was 100% （7/7） ; for stromal abscess type, endothelial or anterior chamber type, simple triple antifungal treatment is ineffective, the effective rate was 85.7% （6/7） in the treatment of B matrix injection or anterior chamber irrigation and amphotericin B after anterior cham- ber injection combined with amphotericin. All 14 cases showed no severe complications. Conclusion The fungal keratitis caused by Chinese chestnut thorns have diversity in ulcers formation; ahernaria and fusarium are the main pathogens; on the basis of clinical types of ulcer to take operation and combined with appropriate antifungal treatment can achieve good therapeu- tic effect.