Thanathanee Onsiri, Bhoomibunchoo Chavakij, Anutarapongpan Orapin, Suwan-Apichon Olan, Yospaiboon Yosanan
KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Int Med Case Rep J. 2017 Mar 20;10:93-95. doi: 10.2147/IMCRJ.S131372. eCollection 2017.
To report a patient with severe keratitis successfully treated by voriconazole.
Case report.
A 37-year-old healthy male presented with irritation, pain and reduced vision in his left eye after mud contamination. Examination demonstrated corneal stromal infiltration, endothelial plaque and hypopyon. Corneal scrapings demonstrated numerous septate hyphae, and specimen cultures were positive for sp. The lesion did not respond to aggressive topical 5% natamycin, 0.15% topical amphotericin B and oral itraconazole. The patient was then treated by topical 1% voriconazole every hour. Intracameral and intrastromal voriconazole injections (50 μg/0.1 mL) were also undertaken. The keratitis was significantly improved after voriconazole.
To the best of the authors' knowledge, this is the first report on the use of voriconazole for keratitis. Voriconazole may be an effective alternative to conventional antifungal agents in some cases of fungal keratitis. It should be considered before shifting to therapeutic keratoplasty.
报告1例成功使用伏立康唑治疗的严重角膜炎患者。
病例报告。
一名37岁健康男性在眼部被泥土污染后，出现左眼刺激感、疼痛及视力下降。检查发现角膜基质浸润、内皮斑及前房积脓。角膜刮片显示大量分隔菌丝，标本培养曲霉菌属阳性。病变对积极的局部5%那他霉素、0.15%局部两性霉素B及口服伊曲康唑均无反应。随后患者每小时接受1%伏立康唑局部治疗。还进行了前房内及基质内伏立康唑注射（50μg/0.1mL）。使用伏立康唑后角膜炎明显改善。
据作者所知，这是关于伏立康唑用于角膜炎治疗的首例报告。在某些真菌性角膜炎病例中，伏立康唑可能是传统抗真菌药物的有效替代药物。在考虑进行治疗性角膜移植术之前应予以考虑。
