Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Chin Med J (Engl). 2009 Aug 20;122(16):1884-8.
Fungal keratitis is a rare but serious corneal disease that may result in loss of vision. The poor prognosis might be due to limited treatment option. This study aimed to evaluate the clinical efficacy of 0.25% terbinafine eye drops comparing with 5% natamycin suspension on fungal keratitis.
A retrospective clinical trial was performed on 90 patients presenting with direct smear and/or culture positive fungal keratitis at Beijing Tongren Hospital, Beijing, China from January 2006 to May 2008. Corneal ulcers were categorized as mild or severe. Forty-five patients were treated with topical terbinafine and the next 45 cases received topical natamycin hourly.
Filamentous fungi were found in corneal scrapings among all 90 cases. Fungal cultures were positive in 64 patients (71%). Species of Fusarium and Aspergillus were the principal isolates. Forty (89%) patients showed favorable response to terbinafine, while forty-two (93%) patients exhibited favorable response to natamycin (P > 0.05). The mean course of treatment was significantly showed in the terbinafine treatment group than natamycin group ((26.5 +/- 11.2) days versus (19.3 +/- 6.4) days; P < 0.05). In terbinafine group, twenty patients with ulcers smaller than 4 mm had favorable outcome, while 20 of 25 patients with ulcers more than 4 mm in diameter had favorable response (P < 0.05). Twenty-seven patients with depth of infiltration less than half of stroma thickness had favorable response to terbinafine, while 13 of 18 patients with depth of infiltration more than half of stroma responded to terbinafine. This difference was statistically significant (P < 0.05).
Our findings suggest that topical terbinafine is an effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases with smaller and shallower ulcers. Its mean duration of treatment was longer than natamycin.
真菌性角膜炎是一种罕见但严重的角膜疾病，可能导致视力丧失。预后较差可能是由于治疗选择有限。本研究旨在评估 0.25%特比萘芬滴眼液与 5%那他霉素混悬液治疗真菌性角膜炎的临床疗效。
对 2006 年 1 月至 2008 年 5 月在北京同仁医院就诊的直接涂片和/或培养阳性真菌性角膜炎患者 90 例进行回顾性临床研究。角膜溃疡分为轻度和重度。45 例患者局部应用特比萘芬，45 例患者局部应用那他霉素，每小时 1 次。
90 例患者角膜刮片均发现丝状真菌。64 例（71%）真菌培养阳性。主要分离物为镰孢菌属和曲霉菌属。特比萘芬组 40 例（89%）患者有良好反应，那他霉素组 42 例（93%）患者有良好反应（P>0.05）。特比萘芬组的平均疗程明显短于那他霉素组（（26.5+/-11.2）天比（19.3+/-6.4）天；P<0.05）。特比萘芬组溃疡直径<4mm 的 20 例患者有良好结局，溃疡直径>4mm 的 25 例患者中有 20 例有良好反应（P<0.05）。浸润深度<基质厚度一半的 27 例患者对特比萘芬有良好反应，浸润深度>基质厚度一半的 18 例患者中有 13 例对特比萘芬有良好反应。差异有统计学意义（P<0.05）。
我们的研究结果表明，局部应用特比萘芬是治疗丝状真菌感染性角膜炎的有效抗真菌药物，特别是在溃疡较小和较浅的情况下。其平均治疗时间长于那他霉素。
