57例(60眼)真菌性角膜炎的药物治疗临床分析

The medical treatment of 60 eyes of 57 cases of fungal keratitis

目的 回顾性总结真菌性角膜溃疡的有效药物治疗的临床表现和病程及治愈率。方法 5 7例 (60只眼 )真菌性角膜溃疡临床表现符合诊断标准。真菌刮片均可见菌丝或孢子体。对发展迅速者采用抗生素 ,如庆大霉素结膜下注射 ,同时用抗生素及抗真菌剂滴眼 (1% 5 -氟胞嘧啶和 0 1～ 0 3 %二性霉素B) ,加强散瞳。急性期在肝功能正常情况下可口服抗真菌药 (酮康唑 ) 1～ 3疗程 ;多种维生素族药物口服 ,坚持全疗程 ;2 5 %碘酊小病灶早期烧灼 ,或大病灶的中晚期烧灼 ,一般不超过三次。结果 5 7例 (60只眼 )经药物治疗 ,其中 45只眼 3～ 11周溃疡治愈 (2 5只眼小溃疡 ,前房无积脓者 ,2～ 4周溃疡愈合 ;2 0只眼溃疡范围大伴前房积脓 ,5～ 11周溃疡愈合 ) ,其余 15只眼(干眼症 3例 6只眼 ,单疱病毒合并真菌感染 6只眼 ,化学烧伤 3只眼 )疗程为 3～ 5个月。合并症病例因病灶穿孔后新生血管深入而愈合。结论 真菌性角膜溃疡有高发倾向 ,无针对性特效药物治疗和手术治疗 ,预后欠佳。早期诊断 ,早期合理用药是治愈的关键。小病灶 ,表浅者用抗真菌剂并及时病灶烧灼效果肯定 ,预后留有浅层斑翳 ;范围较大呈垂直生长的病灶 ,极易穿孔 (多呈细孔状 ) ,预后视力较差。各治疗期均禁用激素 ,病灶愈合后仍应巩固用药

Objective Retrospective analysis of the effective medical treatment for fungal keratitis.The main parameters evaluated were clinical exhibition,course of the disease and cure rate.Methods 57 patients(60 eyes)got correct diagnosis of fungal keratitis.Smear examination has been undertaken,all of the results are positive.Treatment for the severe cases is that subconjunctival injection of antibiotics such as gentamycin,topical therapy with antibiotics and antifungal agents(1% 5-fluorocytosine,0.1～0.3% amphotericin B)at the the same time,dilate pupil.Antifungal drugs are taken orally for 1～3 periods of treatment at acute phase when the liver function is normal.Vitaminization is taken orally from the beginning to the end.Singe the small focus with 2.5% tincture of iodine at early phase,big focus at middle or late phase.It can be used no more than three times.Results Among 57 patients(60 eyes),45 eyes were cured with medical treatment after 3～11 weeks,others were treated for 3～5 months or more.The patients with other diseases were recovered if the blood vessels extend to the focus after perforation.Conclusions Fungal keratitis trends to high morbidity,without definitely effective medical and surgical treatment,has a poor prognosis.Diagnosis and medical treatment at early phase is important.It is meaningful of taking antifungal agents and singe the focus to the small ones,corneal scarring is left at the end.The big and deep focus is prone to perforation(with minute holes)and has a bad eye sight.Medical treatment should be lasted for more than one month after cure.Corticosteroids should never be used.