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[兔模型实验性念珠菌性眼内炎不同抗真菌治疗方案的比较]

[Comparison of different antifungal treatment regimens for experimental Candida endophthalmitis in rabbit models].

作者信息

Koçak Nilüfer, Kaynak Süleyman, Kirdar Sevin, Irmak Ozgür, Bahar I Hakki

机构信息

Dokuz Eylül Universitesi Tip Fakültesi, Göz Hastaliklari Anabilim Dali, Izmir.

出版信息

Mikrobiyol Bul. 2009 Oct;43(4):619-26.

PMID:20084915
Abstract

The aim of this study was to evaluate the treatment options of experimental in-vivo Candida endophthalmitis. For inoculation, a 0.1 ml of suspension of Candida albicans was injected into the vitreous of the right eye of each New Zealand rabbit. On the 15th day, the clinical evaluation for the resultant endophthalmitis was noted, and vitreous samples were obtained. On the 21st day, culture positive eyes were divided into four groups in terms of treatment modalities. Group 1 (n = 7) received intravitreal amphotericin B injection, group 2 (n = 8) received both intravitreal dexamethasone and amphotericin B injections, group 3 (n = 8) underwent pars plana vitrectomy (PPV) and amphotericin B injection, and group 4 (n = 8) underwent PPV and both amphotericin B and silicone oil injections. The vitreous samples obtained from right eyes of the rabbits on the 15th day, were all culture positive for Candida albicans. On the 35th day, the least colony counts (colony forming unit) were present in eyes that received only intravitreal amphotericin B injection in group 1, followed by group 4 that underwent PPV and both amphotericin B and silicone oil injections. In Candida endophthalmitis, intravitreal injection of amphotericin B without steroid appears to be the primary choice of therapy. In cases who fail to respond to this regimen alone, PPV in combination with silicone oil injection may be considered. Benefit-risk ratio should be cautiously interpreted for application of intravitreal steroid injection.

摘要

本研究的目的是评估实验性体内念珠菌性眼内炎的治疗方案。为进行接种,将0.1 ml白色念珠菌悬液注入每只新西兰兔右眼的玻璃体。在第15天,对由此产生的眼内炎进行临床评估,并获取玻璃体样本。在第21天,根据治疗方式将培养阳性的眼睛分为四组。第1组(n = 7)接受玻璃体内注射两性霉素B,第2组(n = 8)接受玻璃体内地塞米松和两性霉素B联合注射,第3组(n = 8)进行玻璃体切割术(PPV)并注射两性霉素B,第4组(n = 8)进行PPV并注射两性霉素B和硅油。在第15天从兔右眼获取的玻璃体样本,白色念珠菌培养均为阳性。在第35天,第1组仅接受玻璃体内注射两性霉素B的眼睛中菌落计数(菌落形成单位)最少,其次是第4组进行了PPV并注射两性霉素B和硅油的眼睛。在念珠菌性眼内炎中,不使用类固醇的玻璃体内注射两性霉素B似乎是主要的治疗选择。对于单独使用该方案无反应的病例,可考虑PPV联合硅油注射。对于玻璃体内注射类固醇的应用,应谨慎解释其效益风险比。

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Efficacy of vitrectomy in improving the outcome of Bacillus cereus endophthalmitis.玻璃体切除术对改善蜡样芽孢杆菌性眼内炎结局的疗效。
Retina. 2011 Sep;31(8):1518-24. doi: 10.1097/IAE.0b013e318206d176.
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Severe bacterial endophthalmitis: towards improving clinical outcomes.
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Expert Rev Ophthalmol. 2010 Oct;5(5):689-698. doi: 10.1586/eop.10.52.