深基质真菌性角膜炎综合治疗方案的疗效评估

doi:10.3760/cma.j.cn115909-20191218-00332

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Abstract Objective: To evaluate the efficacy and safety of a comprehensive treatment regimen based on intrastromal voriconazole injection in the treatment of deep stromal fungal keratitis in which the lesion has infiltrated more than half of the corneal stroma. Methods: This was a retrospective study. Sixty-two patients (62 eyes) with deep stromal fungal keratitis who underwent intrastromal voriconazole injection were selected at the Eye Hospital, Wenzhou Medical University from March 2013 to July 2017. Age, the diameter of the ulcer, cure rate, recurrence rate, complications, etc., were measured. All the patients were followed up for at least 6 months. Sixty-two patients were divided into an effective group (EGII) and an ineffective group (IGII) based on the effect of the pure intrastromal voriconazole injection. The data were analyzed by an independent samples t-test and Chi-square test. Results: The 62 patients had ulcer diameters ranging from 2.8 to 11.0 (5.5±2.1)mm. The time from onset to treatment for the 62 patients ranged from 2 days to 2 years (44.2±98.6)days. Six patients sought treatment more than half a year after onset, and the remaining 56 patients had an onset time of 21.2±13.6 days. All patients were followed up for 6 to 36 (10.5±7.5)months. Forty-two patients (42 eyes) were cured by pure intrastromal voriconazole injection, 1 patient (1 eye) underwent a corneal transplant to improve vision after intrastromal voriconazole injection was effective; 19 patients (19 eyes) underwent conjunctival flap coverage after the injection failed. Combined with conjunctival flap coverage, 11 eyes were cured, 8 eyes required corneal transplants, and 2 patients relapsed after corneal transplants. The cure rate of the comprehensive treatment regimen was 85.5%, and the recurrence rate was 3.2%. The EGII group had a smaller ulcer diameter than the IGII group, and the difference between the two groups was statistically significant (t=-2.199, P=0.032). There were no complications during or after the operation. Conclusions: Intrastromal voriconazole injection has a safe and beneficial effect on deep stromal fungal keratitis that does not respond to conventional drugs. For eyes with a wide range of lesions, the effect of pure intrastromal voriconazole injection was not good, but the cure rate can be improved when treatment is combined with conjunctival flap coverage.

Key words： fungal keratitis voriconazole corneal intrastromal injection conjunctival flap coverage

Received: 18 December 2019

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Corresponding Authors: Wei Chen, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China (Email: chenweimd@hotmail.com)

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https://www.cjoovs.com/EN/ 10.3760/cma.j.cn115909-20191218-00332 OR https://www.cjoovs.com/EN/Y2020/V22/I10/750

[1]	Srinivasan M. Fungal keratitis. Curr Opin Ophthalmol, 2004, 15(4): 321-327. DOI: 10.1097/00055735-200408000-00008.
[2]	汪斌, 胡巧娟, 李春丽. 镰刀菌属感染致眼球摘除1例. 武警后勤学院学报(医学版), 2018, 27(7): 621-622.
[3]	Kaur IP, Rana C, Singh H. Development of effective ocularpreparations of antifungal agents. J Ocul Pharmacol Ther, 2008, 24(5): 481-493. DOI: 10.1089/jop.2008.0031.
[4]	O'Day DM, Head WS, Robinson RD, et al. Corneal penetration of topical amphotericin B and natamycin. Curr Eye Res, 1986, 5(11): 877-882. DOI: 10.3109/02713688609029240.
[5]	Austin A, Lietman T, Rose-Nussbaumer J. Update on the management of infectious keratitis. Ophthalmology, 2017, 124(11): 1678-1689. DOI: 10.1016/j.ophtha.2017.05.012.
[6]	Diekema DJ, Messer SA, Hollis RJ, et al. Activities of caspofungin, itraconazole, posaconazole, ravuconazole, voriconazole, and amphotericin B against 448 recent clinical isolates of filamentous fungi. J Clin Microbiol, 2003, 41(8): 3623-3626. DOI: 10.1128/jcm.41.8.3623-3626.2003.
[7]	王倩, 罗丹, 陈华波, 等. 3 759例角膜炎患者真菌检测与耐药性分析. 中国真菌学杂志, 2019, 14(1): 16-19. DOI: 10.3969/ j.issn.1673-3827.2019.01.005.
[8]	Prakash G, Sharma N, Goel M, et al. Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis. Am J Ophthalmol, 2008, 146(1): 56-59. DOI: 10.1016/ j.ajo.2008.02.023.
[9]	Sharma N, Chacko J, Velpandian T, et al. Comparative evaluation of topical versus intrastromal voriconazole as an adjunct to natamycin in recalcitrant fungal keratitis. Ophthalmology, 2013, 120(4): 677-681. DOI: 10.1016/ j.ophtha.2012.09.023.
[10]	Kalaiselvi G, Narayana S, Krishnan T, et al. Intrastromal voriconazole for deep recalcitrant fungal keratitis: A case series. Br J Ophthalmol, 2015, 99(2): 195-198. DOI: 10.1136/ bjophthalmol-2014-305412.
[11]	Sharma N, Agarwal P, Sinha R, et al. Evaluation of intrastromal voriconazole injection in recalcitrant deep fungal keratitis: Case series. Br J Ophthalmol, 2011, 95(12): 1735-1737. DOI: 10.1136/bjo.2010.192815.
[12]	Siatiri H, Daneshgar F, Siatiri N, et al. The effects of intrastromal voriconazole injection and topical voriconazole in the treatment of recalcitrant Fusarium keratitis. Cornea, 2011, 30(8): 872-875. DOI: 10.1097/ICO.0b013e3182100993.
[13]	程蕾, 张明昌. 真菌性角膜炎诊断常规及新进展. 临床眼科杂志, 2005, 13(5): 477-479. DOI: 10.3969/j.issn.1006-8422. 2005.05.052.
[14]	Neoh CF, Leung L, Vajpayee RB, et al. Treatment of Alternaria keratitis with intrastromal and topical caspofungin in combination with intrastromal, topical, and oral voriconazole. Ann Pharmacother, 2011, 45(5): e24. DOI: 10.1345/aph.1P586.
[15]	Tanure MA, Cohen EJ, Sudesh S, et al. Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania. Cornea, 2000, 19(3): 307-312. DOI: 10.1097/00003226- 200005000-00010.
[16]	王丽娅, 张月琴, 王印其. 中国三地区真菌性角膜病致病菌种的调查. 中华眼科杂志, 2000, (2): 138-140. DOI: 10.3760/ j:issn:0412-4081.2000.02.017.
[17]	O'Day DM. Selection of appropriate antifungal therapy. Cornea, 1987, 6(4): 238-245. DOI: 10.1097/00003226-198706040- 00002.
[18]	Gugnani HC, Talwar RS, Njoku-Obi AN, et al. Mycotic keratitis in Nigeria. A study of 21 cases. Br J Ophthalmol, 1976, 60(9): 607-613. DOI: 10.1136/bjo.60.9.607.
[19]	贺燚, 孙秉基, 赵东卿, 等. 真菌性角膜炎的临床特征及疗效观察. 中华眼科杂志, 2000, 36(5): 358-361. DOI: 10.3760/ j:issn:0412-4081.2000.05.011.
[20]	瞿玲辉, 李良毛. 真菌性角膜炎的药物治疗进展. 眼科研究, 2010, 28(2): 178-182. DOI: 10.3969/j.issn.1003-0808.2010.02. 021.
[21]	白利广. 角膜基质内注射不同药物治疗不同病原菌感染所致真菌性角膜炎. 实用医学杂志, 2018, 34(7): 1183-1187. DOI: 10.3969/j.issn.1006-5725.2018.07.033.
[22]	Niki M, Eguchi H, Hayashi Y, et al. Ineffectiveness of intrastromal v-oriconazole for filamentous fungal keratitis. Clin Ophthalmol, 2014, 8(8): 1075-1079. DOI: 10.2147/OPTH. S63516.
[23]	Shen YC, Wang MY, Wang CY, et al. Pharmacokinetics of intracameral voriconazole injection. Antimicrob Agents Chemother, 2009, 53(5): 2156-2157. DOI: 10.1128/AAC.01125- 08.
[24]	Tu EY. Alternaria keratitis: Clinical presentation and resolution withtopical fluconazole or intrastromal voriconazole and topical caspofungin. Cornea, 2009, 28(1): 116-119. DOI: 10.1097/ ICO.0b013e31818225f8.
[25]	李素霞, 史伟云, 刘明娜, 等. 结膜瓣遮盖术治疗难治性角膜溃疡. 眼科新进展, 2007, 27(3): 204-207. DOI: 10.3969/ j.issn.1003-5141.2007.03.013.
[26]	赵倩, 王婷, 史伟云, 等. 角膜移植术后复发性真菌性角膜炎的治疗及疗效分析. 中华实验眼科杂志, 2015, 33(4): 338-341. DOI: 10.3760/cma.j.issn.2095-0160.2015.04.010.
[27]	Ti SE, Scott JA, Janardhanan P, et al. Therapeutic keratoplasty for advanced suppurative keratitisl. Am J Ophthalmol, 2007, 143(5): 755-762. DOI: 10.1016/j.ajo.2007.01.015.
[28]	谢立信, 王富华, 史伟云. 1997至2002年山东省眼科研究所穿透性角膜移植术的原因分析. 中华眼科杂志, 2006, 42(8): 704-708. DOI: 10.3760/j:issn:0412-4081.2006.08.007.
[29]	Xie L, Hu J, Shi W. Treatment failure after lamellar keratoplasty for fungal keratitis. Ophthalmology, 2008, 115(1): 33-36. DOI: 10.1016/j.ophtha.2007.03.072.
[30]	王蕊. 糖尿病真菌性角膜炎患者临床特征及病原学分析. 中国真菌学杂志, 2017, 12(04): 221-224. DOI: 10.3969/ j.issn.1673-3827.2017.04.007.
[31]	黎明明, 丘亮辉, 赖江峰, 等. 糖尿病对真菌性角膜炎患者感染程度及预后的影响. 眼科新进展, 2016, 36(8): 763-766. DOI: 10.13389/j.cnki.rao.2016.0204.

[1]	. [J]. Chinese Journal of Optometry Ophthalmology and Visual science, 2023, 25(8): 0-.