Natamycin in the treatment of fungal keratitis : a systematic review and Meta-analysis

AIM: To review published clinical studies examining the effect of natamycin in the treatment of fungal keratitis.METHODS: We selected the publications in CENTRAL,MEDLINE, EMBASE, CNKI, and CBM. This study systematically reviewed published randomized controlled trials(RCTs) that compared natamycin to other antifungal agents, and conducted feasible Meta-analysis of efficacy results using Revman 5.2 software.RESULTS: We included seven trials which were mainly carried out in developing countries of Asia, with five trials conducted in India, one each in China and Bangladesh. A total of 804 participants were randomized to following comparisons: 2% econazole versus 5%natamycin showed little difference in the effects of treatment of fungal keratitis [RR =0.99, 95% confidence interval(CI), 0.8 to 1.21]; chlorhexidine gluconate versus5% natamycin indicated that the results on healing of the ulcer at 21 d was less conclusive(RR=0.77, 95% CI, 0.55 to 1.08; I2=0%); 1% voriconazole versus 5% natamycin suggested that natamycin treatment appeared to be significantly better outcomes than voriconazole(regression coefficient =-0.18 log MAR; 95% CI,-0.30 to-0.05; P =0.006), especially in Fusarium cases(regression coefficient=-0.41 log MAR; 95% CI,-0.61 to-0.20; P 【0.001);natamycin versus fluconazole showed a significant difference in cure rate(χ2=5.048, P 【0.05) and natamycin group was more effective than fluconazole in average period of therapy(t =7.94, P 【0.01).CONCLUSION: Natamycin was a preferable choice in the treatment of fungal keratitis, especially in the early period of Fusarium cases.

Effect of corneal graft diameter on therapeutic penetrating keratoplasty for fungal keratitis

AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. RESULTS: Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P = 0.961), corneal graft dear rate (P=0.132) or the incidence of recurred fungal infection (P=0.770) between two groups. But there was a higher incidence of graft rejection (P=0.020) and secondary glaucoma (P=0.039) in group with corneal graft diameter 8.00mm or larger. CONCLUSION: PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis.Effective, preventive and therapeutic measures can improve the prognosis.

Etiological analysis on ocular fungal infection in the period of 1989-2000

Background This study was to review the distribution and shifting trend of fungal of culture specimens isolated from eyes of patients at the Beijing Institute of Ophthalmology, Tongren Hospital, Beijing, China.Methods The fungal culture-positive rate, the distribution and change of isolates of 2609 specimens collected in a 12-year period (1989-2000) were retrospectively analyzed.Results In 775 positive cultures, 707 specimens (91.2%) were from the cornea, 22 (2.8%) from the conjunctiva, 15 (1.9%) from the anterior chamber, 9 (1.2%) from the vitreous body, 3 (0.4%) from the lacrimal sac, and 19 (2.5%) from other parts of the eye. The average culture-positive rate was 29.7%. The ratio of the positive cultures in the first half year (from January to June) to those in the second half (from July to December) was 1∶2.1. The main genus cultured was Fusarium sp (58.7%), followed by Aspergirum sp (16.8%). The percentage of Fusarium sp was increased from 53.6% (1989-1994) to 60.2% (1995-2000), whereas the percentage of Aspergirum sp was decreased from 22.3% (1989-1994) to 15.1% (1995-2000). Conclusions Fusaruim sp is one of the most predominant pathogens of ocular fungal infection in northern China and its incidence tends to increase, but that of Aspergirum sp to decrease. It is very important to recognize the distribution and shifting trend of pathogenic fungi in the diagnosis, prevention and treatment of fungal keratitis.

氟康唑联合羊膜移植治疗真菌性角膜溃疡的临床观察

【目的】观察单纯氟康唑治疗与氟康唑联合羊膜移植治疗在真菌性角膜溃疡中的临床疗效。【方法】5 3例真菌性角膜溃疡患者 ,分为A组 (2 1例 ) ,即氟康唑联合羊膜移植治疗组和B组 (32例 ) ,即单纯氟康唑治疗组。比较A、B两组的治愈率、疗程及并发症。【结果】A组治愈 19例 (90 .5 % ) ,治愈时间 9～ 2 5 (12 .0± 3.8)d ;B组 2 4例 (75 % ) ,治愈时间 17～ 5 9(2 8.0± 6 .4 )d ;A组无角膜穿孔及眼内炎等导致的眼球摘除等严重并发症。A、B两组治愈率比较经统计学处理无明显差异 (P >0 .0 1) ,但A组明显缩短了疗程 ,经统计学处理 ,两组间有明显差异 (P <0 .0 1)。【结论】氟康唑联合羊膜移植治疗真菌性角膜溃疡是一有效的治疗方法。

玻璃体切割联合眼内注药治疗内源性真菌性眼内炎的疗效

【目的】探讨内源性真菌性眼内炎的临床特点及治疗方法。【方法】回顾性分析6例11只眼内源性真菌性的眼内炎的治疗过程及病原学特点。【结果】11只眼均经过术前术中玻璃体腔注药及玻璃体切割术，并辅以全身及局部抗真菌药物治疗，其中5例患者保住眼球，3只眼保留有用视力，5只眼为光感至指数视力，2只眼眼球萎缩，1例治疗失败。【结论】外科手术及术后长期使用抗生素是引起内源性眼内炎的重要诱因；内源性真菌性眼内炎是一种危害严重的致盲眼病，玻璃体腔注药联合玻璃体切割术是目前治疗内源性真菌性眼内炎的有效方法。