Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy.
Indian J Ophthalmol. 2013 Nov;61(11):669-71. doi: 10.4103/0301-4738.120213.
A 39-year-old woman presented to our hospital with a history of photorefractive keratectomy (PRK), performed two weeks prior; slit-lamp examination revealed diffuse conjunctival congestion, corneal ulcer and stromal infiltration. After 5 days of antifungal and antibacteric treatment, the infiltrate progressively increased so that a therapeutic penetrating keratoplasty was necessary. The microbiological analyses revealed the presence of fungal filaments. Twenty days after surgery the patient had recurrent fungal infiltrate in the donor cornea with wound dehiscence. We performed a second penetrating keratoplasty. With the matrix-assisted-laser-desorption-ionization-time-of-flight analysis (MALDI-TOF) we identified a Fusarium solani. Intravenous amphothericine B, a combination of intracameral and intrastromal voriconazole and intracameral amphotericine B were administered. After 6 months from the last surgery the infection was eradicated. The management of fungal keratitis after PRK depends on many factors: In our experience, a prompt keratoplasty and the use of intracameral antifungal medication proved to be very effective.
一位 39 岁女性因两周前行光性角膜切削术（PRK）就诊于我院；裂隙灯检查显示弥漫性结膜充血、角膜溃疡和基质浸润。抗真菌和抗菌治疗 5 天后，浸润逐渐加重，因此需要进行治疗性穿透性角膜移植。微生物分析显示存在真菌丝。术后 20 天，供体角膜出现复发性真菌浸润伴伤口裂开。我们进行了第二次穿透性角膜移植。基质辅助激光解吸电离飞行时间分析（MALDI-TOF）鉴定出一株茄病镰刀菌。给予静脉注射两性霉素 B、玻璃体内和基质内伏立康唑以及玻璃体内两性霉素 B 联合治疗。末次手术后 6 个月，感染得到清除。PRK 后真菌性角膜炎的治疗取决于多种因素：根据我们的经验，及时的角膜移植和使用玻璃体内抗真菌药物非常有效。
