角膜基质内注射伏立康唑治疗真菌性角膜炎的临床疗效及安全性观察

Clinical observation of voriconazole injection in corneal stroma for the treatment of fungal keratitis

目的:评价角膜基质内注射伏立康唑治疗真菌性角膜炎的临床疗效和安全性。方法:选择角膜刮片或结膜囊涂片证实为真菌性角膜炎并常规治疗2周无效的患者19例(19眼)。于病灶区角膜基质内注射伏立康唑(50μg/0.1m L)。术后继续使用局部、口服抗真菌药物治疗,观察角膜情况及前房情况。结果:本组患者19例进行角膜基质内注射伏立康唑注射液,术后联合抗真菌滴眼液及全身药物治疗。3例患者(15.8%)角膜基质单次注药后好转,8例患者(42.1%)重复注药后好转。9例患者(47.4%)角膜基质注药后出院时视力明显提高,17例患者(89.5%)出院时角膜浸润面积减少,10例患者(83.3%)前房积脓减少或消失,2例患者(66.7%)角膜内皮斑显著减少。术后随访6月,未发现继发性眼内炎和青光眼等。结论:角膜基质内注射伏立康唑治疗真菌性角膜炎安全有效,短期内无明显并发症。

Objective： To investigate the clinical efficacy and safety of fluconazol injection in coneal stroma. Methods： We selected 19 patients （19 eyes） with fungal keratitis who had received conventional treatment for 2 weeks without any clinical effect. These patients were injected with voriconazole in the involved corneal stroma after regular sterilization, and therapeutic effect was evaluated. Results： 19 patients were cured by the combination of voriconazole injection in corneal stroma and local and systemic anti-fungal drugs. Three patients （15.8%） got better after single intrastromal injection of voriconazole. Eight patients got better （42.1%） after repeated injection. Nine patients＇ （47.4%） visual acuity got improved, 17 patients＇ （89.5%） corneal infiltration area was reduced, 10 patients＇ （83.3%） anterior chamber empyema were reduced or disappear and two patients＇ （66.7%） corneal endothelium fleck was significantly reduced when they were discharged from hospital. Postoperative follow-up was conducted 6 months later, and there were no secondary endophthalmitis and glaucoma. Conclusion： Voriconazole injection in corneal stroma is a safety and effective way to control and treat the fungal keratitis without complications in the short-term use.