Department of Clinical Ophthalmology, Moorfields Eye Hospital NHS Trust, London, UK.
Eye (Lond). 2009 Jun;23(6):1308-13. doi: 10.1038/eye.2008.298. Epub 2008 Oct 3.
To describe the incidence and current management of fungal keratitis in the United Kingdom.
Cases were identified prospectively through the British Ophthalmologic Surveillance Unit (BOSU) from December 2003 to November 2005. Questionnaire data were requested at diagnosis and at 6 months follow-up. Inclusion criteria were a positive culture or microsopic proof from a scraping or biopsy, and a normal residence in the United Kingdom.
Data were available on 39 confirmed cases at diagnosis and 34 cases at follow-up. The minimum average annualised incidence was 0.32 (95% CI, 0.24-0.44) cases per million individuals. In 22 cases (56%), only Candida was isolated and 14 of these (63%) had prior ocular surface disease treated with topical steroid. A filamentary fungus infection was more common in male patients (P=0.02), often following trauma, and the differences in risk factors between types of fungal infection was statistically significant (P<0.001). One case had a mixed yeast and filamentary fungus infection. The most frequent initial topical therapies were amphotericin B (38%) or econazole (28%). In addition, oral fluconazole was used in 11 (31%) patients and oral itraconazole in six (15%). At follow-up, the vision in 15 eyes (44%) was <6/60 including three eyes eviscerated.
This study provides data on the minimum incidence of fungal keratitis in the United Kingdom. It provides evidence of frequent delay in diagnosis after presentation to eye departments, inconsistent management, and poor outcome. Issues that can now be addressed.
描述英国真菌性角膜炎的发病率和当前治疗方法。
通过英国眼科监测单位（BOSU）从 2003 年 12 月至 2005 年 11 月进行前瞻性病例发现。在诊断时和 6 个月随访时请求问卷调查数据。纳入标准为阳性培养或刮片或活检的显微镜证据，以及在英国的正常居住。
在诊断时有 39 例确诊病例和 34 例随访病例的数据。最低平均年化发病率为每百万个体 0.32 例（95%CI，0.24-0.44）。在 22 例（56%）中，仅分离出念珠菌，其中 14 例（63%）有先前经局部皮质类固醇治疗的眼表疾病。丝状真菌感染在男性患者中更为常见（P=0.02），通常发生在创伤后，不同类型真菌感染的危险因素之间存在统计学显著差异（P<0.001）。有 1 例混合酵母和丝状真菌感染。最初最常用的局部治疗是两性霉素 B（38%）或克霉唑（28%）。此外，11 例（31%）患者使用氟康唑口服，6 例（15%）患者使用伊曲康唑口服。随访时，15 只眼睛（44%）的视力<6/60，包括 3 只眼睛被挖出。
本研究提供了英国真菌性角膜炎最低发病率的数据。它提供了在眼科部门就诊后诊断延迟频繁、治疗方法不一致和预后不良的证据。现在可以解决这些问题。
