Proença-Pina Julia, Ssi Yan Kai Isabelle, Bourcier Tristan, Fabre Monique, Offret Hervé, Labetoulle Marc
Department of Ophthalmology, Bicêtre University Hospital, APHP, University Paris XI, Le Kremlin Bicêtre, Paris, France.
Int Ophthalmol. 2010 Feb;30(1):103-7. doi: 10.1007/s10792-008-9290-7. Epub 2009 Apr 10.
Fusarium keratitis is a severe corneal infection that is usually seen in tropical and subtropical countries after a corneal trauma. In 2005-2006, an epidemic of Fusarium keratitis, occurring predominantly among contact lens wearers, was observed in several countries.
We describe the clinical course of a Fusarium keratitis which failed to respond to systemic and local voriconazole treatment, and experienced a progression to a severe keratitis with endophthalmitis, requiring early therapeutic keratoplasty ("à chaud"). After 8 months of follow up, the vision recovered to 20/50.
After the 2005-2006 worldwide epidemics, case-control studies pointed out that a new lens care solution, ReNu with MoistureLoc (Bausch & Lomb), was likely responsible of numerous cases. Complementary studies underlined that this infection mostly concerned non-compliant patients, i.e., those reusing the solution several times, since this results in a decrease of the antifungal activity due to the uptake of the biguanides into the lens.
Fusarium endophtalmitis can result in a devastating disease with a poor visual outcome. An initial antifungal dual therapy may control the infection. In case of failure, an early keratoplasty may be mandatory. For contact lens wearers, education on sanitary good practice is necessary to avoid new epidemics in the future.
镰刀菌角膜炎是一种严重的角膜感染，通常在热带和亚热带国家角膜外伤后出现。2005 - 2006年，在几个国家观察到主要发生在隐形眼镜佩戴者中的镰刀菌角膜炎流行。
我们描述了一例镰刀菌角膜炎的临床病程，该病例对全身及局部伏立康唑治疗无效，并进展为伴有眼内炎的严重角膜炎，需要早期治疗性角膜移植术（“趁热”）。经过8个月的随访，视力恢复到20/50。
在2005 - 2006年全球疫情之后，病例对照研究指出，一种新的镜片护理液，即爱尔康的ReNu with MoistureLoc，可能是众多病例的病因。补充研究强调，这种感染主要涉及不依从的患者，即那些多次重复使用护理液的患者，因为这会导致由于双胍类药物被镜片吸收而使抗真菌活性降低。
镰刀菌性眼内炎可导致严重疾病且视力预后不佳。初始的抗真菌双联疗法可能控制感染。若治疗失败，早期角膜移植术可能是必要的。对于隐形眼镜佩戴者，进行良好卫生习惯的教育对于避免未来新的疫情是必要的。
