角膜基质内注射氟康唑联合匹马霉素滴眼液治疗真菌性角膜炎的疗效观察

Fluconazol intrastromal injection combined with natamycin eye drops in the treatment of fungal keratitis

目的观察角膜基质内注射氟康唑联合匹马霉素滴眼液治疗真菌性角膜炎的疗效。方法选择常规用药方式治疗无效的真菌性角膜炎患者42例（42只眼）,在匹马霉素滴眼液点眼治疗的基础上采用0.2%氟康唑角膜基质内注射,观察其疗效及不良反应发生情况。结果 42例中36例（85.7%）痊愈,治愈时间为12~30 d,平均（19.3±4.9）d,5例经手术治愈,1例最终摘除眼球。1例患者在第5次注射后突然出现眼部刺激症状,给予双氯酚酸钠滴眼液点眼,2d后症状消失。所有病例随访1~3个月,无穿刺道瘢痕形成,治愈者无复发。结论对常规治疗无效的真菌性角膜炎患者采用角膜基质内注射氟康唑联合匹马霉素滴眼液点眼可取得良好的治疗效果。

Objective To observe the effects of Fluconazol intrastromal injection combined with natamycin eye drops in the treatment of fungal keratitis.Methods Forty-two patients with fungal keratitis that was refractory to traditional treatments were enrolled in this study.Patients were treated with 0.2% fluconazole injection and natamycin eye drops.Efficacy of the regimen and occurrence of adverse reactions were examined.Results In all 42 cases,36 were cured（85.7%）.Healing time was 12~30 days（ average 19.3 ± 6.2 days）.Corneal surgery was needed in 5 cases.One patient required enucleation at last.Irritation was observed in one patient after 5 injections,but resolved with a 2-day course of tropical diclofenac.All patients were followed up for 1~3 months.There were no puncture tract scarring or recurrence.Conclusion Intrastromal injection Fluconazol with tropical use of natamycin can provide good therapeutic effects for refractory fungal keratitis.