Sonego-Krone Sergio, Sanchez-Di Martino Daniel, Ayala-Lugo Rosa, Torres-Alvariza Guillermo, Ta Christopher N, Barbosa Luciene, de Kaspar Herminia Miño
Department of Ophthalmology, Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay.
Graefes Arch Clin Exp Ophthalmol. 2006 Jul;244(7):782-7. doi: 10.1007/s00417-005-1127-8. Epub 2005 Aug 18.
Fungal keratitis is a rare but serious condition that may result in loss of vision. The potentially poor prognosis might be due to a delay in diagnosis and/or to limited treatment options. The aim of this study is to evaluate the clinical outcome of patients treated with topical fluconazole 0.2% for the treatment of filamentous fungal keratitis.
Retrospective case series. A chart review of all patients evaluated at the Ophthalmology Department of the Hospital de Clínicas in Paraguay from January 1997 to December 2000 identified 25 cases of fungal keratitis. Among these cases, one patient discontinued the treatment and another received amphotericin as the first line drug, resulting in 23 cases available for data analysis. Twelve patients were treated with topical fluconazole 0.2% alone (Group I) and 11 patients received a combination of topical fluconazole 0.2% and oral ketoconazole 200 mg twice daily (Group II).
Sixteen of 23 cases showed resolution of the keratitis, 9/12 (75%) in Group I and 7/11 (64%) in Group II. Seven patients (30%) did not respond to medical treatment and required a surgical procedure to preserve eye integrity. Superficial and small ulcers have a significantly better prognosis than do lrge and deep ulcers. Concomitant oral ketoconazole (400 mg/day) did not improve the clinical results.
Our findings of study suggest that topical fluconazole 0.2% is a safe and effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases that are not severe. The addition of oral ketoconazole to topical fluconazole did not improve the clinical outcome.
真菌性角膜炎是一种罕见但严重的疾病，可能导致视力丧失。其预后可能较差，这可能是由于诊断延迟和/或治疗选择有限。本研究的目的是评估用0.2%氟康唑滴眼液治疗丝状真菌性角膜炎患者的临床疗效。
回顾性病例系列研究。对1997年1月至2000年12月在巴拉圭临床医院眼科评估的所有患者病历进行回顾，确定了25例真菌性角膜炎病例。在这些病例中，1例患者中断治疗，另1例患者接受两性霉素作为一线药物治疗，因此有23例可用于数据分析。12例患者仅接受0.2%氟康唑滴眼液治疗（第一组），11例患者接受0.2%氟康唑滴眼液联合口服酮康唑200mg，每日2次治疗（第二组）。
23例中有16例角膜炎症状消退，第一组9/12（75%），第二组7/11（64%）。7例患者（30%）药物治疗无效，需要进行手术以维持眼球完整性。浅表性小溃疡的预后明显优于大而深的溃疡。联合口服酮康唑（400mg/天）并未改善临床疗效。
我们的研究结果表明，0.2%氟康唑滴眼液是治疗丝状真菌性角膜炎的一种安全有效的抗真菌药物，尤其是在病情不严重的情况下。在局部使用氟康唑的基础上加用口服酮康唑并不能改善临床疗效。
