玻璃体腔注射两性霉素B治疗真菌性眼内炎有效性和安全性的系统评价

The efficacy and safety of intravitreal injection of amphothericin B in the treatment of fungal endophthalmitis: a systematic review

目的 评价玻璃体腔注射两性霉素B治疗真菌性眼内炎的有效性和安全性,为临床提供决策依据。方法 计算机检索PubMed、Embase等数据库,收集关于玻璃体腔注射两性霉素B治疗真菌性眼内炎的有效性和安全性的临床研究,检索时限均从建库至2022年4月30日。按纳排标准筛选文献、提取资料并评价质量后,采用定性分析方法描述研究结果。结果 纳入13篇研究,共计321只眼,每个研究为4~113只,平均随访0.8~11.8月。研究干预措施为玻璃体腔注射两性霉素B或联合其他治疗。干预后,对视功能有利的占11.8%~91.7%,对眼解剖结构有利的占40.0%~100.0%,对临床结局有利的占50.0%~100.0%。未见任何关于玻璃体腔注射两性霉素B的眼内或全身系统不良反应报告。结论 对于真菌性眼内炎患者,建议玻璃体腔注射两性霉素B进行经验性治疗,建议根据真菌类型和(或)药物敏感试验选择玻璃体腔注射两性霉素B进行治疗。该方案尚需进一步开展高质量随机对照试验或队列研究验证。

Objective To evaluate the efficacy and safety of intravitreal injection of amphotericin B in the treatment of fungal endophthalmitis,and provide reference for clinical decision making. Methods PubMed,Embase,and other databases were searched by computer. Clinical studies on the efficacy and safety of intravitreal amphothericin B in the treatment of fungal endophthalmitis were collected from the database establishment to April 30,2022. Two evaluators independently screened the literature according to the inclusion and exclusion criteria,extracted the data,and evaluated the quality. Qualitative analysis was used to describe the results. Results Thirteen studies were included,with a total of 321 eyes,each study ranged from 4 to 113eyes,with an average follow-up of 0. 8-11. 8 months. The study intervention was intravitreal injection of amphotericin B or in combination with other treatments. After the intervention,the favorable visual function rate was 11. 8%-91. 7%. The favorable anatomy rate was 40. 0%-100. 0%. The favorable clinical outcome rate was 50. 0%-100. 0%. There were no reports of intraocular or systemic adverse reactions to intravitreal amphotericin B injection. Conclusion Intravitreal injection of amphotericin B is recommended for patients with fungal endophthalmitis,and it is recommended to choose this drug for treatment based on fungal type and/or drug sensitivity test. The recommendation needs to be further validated by high-quality RCT or cohort studies.