Inoue Yoshitsugu, Ohashi Yuichi, Suzuki Takashi, Shimomura Yoshikazu, Fukuda Masahiko, Sotozono Chie, Hatano Hiroshi, Eguchi Hiroshi, Araki-Sasaki Kaoru, Hoshi Saichi, Sunada Atsuko, Asari Seishi, Yaguchi Takashi, Makimura Koichi, Yokokura Shunji, Mochizuki Kiyofumi, Monden Yu, Nejima Ryohei
Nippon Ganka Gakkai Zasshi. 2016 Jan;120(1):5-16.
To investigate the current status of fungal keratitis in Japan.
The patients with fungal keratitis were examined at 27 facilities in Japan from November 1st 2011 to October 31st 2013, concerning isolates, patient background, clinical findings, treatment and prognosis.
Out of 139 cases, 133 were diagnosed as fungal keratitis, of which fungi were isolated from 72 samples of 71 cases (yeast-like fungi 32 strains and filamentous fungi 40 strains). The corrected visual acuity at the first visit of 88 cases (66.2%) was less than 20/200 and 42 cases (31.6%) were involved with deep stromal lesions, indicating high proportion of severe cases in this study. Three months later, 56 cases (42.1%) were still under treatment, and corrected visual acuity of 57 cases (42.9%) was less than 20/200. In cases with yeast-like fungi, there were significantly more cases with past history of corneal diseases, ocular surgery including keratoplasty, and eye drops' use such as steroids than those with filamentous fungi. On the other hand, there were significantly more cases of filamentous fungi, with trauma on the onset and with intervention of previously attending doctors than those with yeast-like fungi. Logistic regression analyses revealed that contact lens wearing was a significant factor of good prognosis, and yeast-like fungi as one of poor outcome compared with no fungal isolation.
Although the choice of antifungal drugs has been increasing, fungal keratitis is still severe, refractory and vision-threatening disease.
调查日本真菌性角膜炎的现状。
2011年11月1日至2013年10月31日期间，对日本27家医疗机构的真菌性角膜炎患者进行了检查，内容包括分离菌株、患者背景、临床症状、治疗及预后情况。
139例患者中，133例被诊断为真菌性角膜炎，其中71例患者的72份样本中分离出真菌（酵母样真菌32株，丝状真菌40株）。88例患者（66.2%）初诊时矫正视力低于20/200，42例患者（31.6%）伴有深层基质病变，表明本研究中重症病例比例较高。3个月后，56例患者（42.1%）仍在接受治疗，57例患者（42.9%）矫正视力低于20/200。酵母样真菌患者中，有角膜疾病史、包括角膜移植术在内的眼部手术史以及使用过类固醇等眼药水的患者明显多于丝状真菌患者。另一方面，丝状真菌患者中，发病时有外伤史以及曾有主治医生干预的患者明显多于酵母样真菌患者。逻辑回归分析显示，佩戴隐形眼镜是预后良好的一个重要因素，与未分离出真菌相比，酵母样真菌是预后不良的因素之一。
尽管抗真菌药物的选择越来越多，但真菌性角膜炎仍然是一种严重、难治且威胁视力的疾病。
