Nada Waled Mahdy, Al Aswad Mahmoud A, El-Haig Wael M
Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Clin Ophthalmol. 2017 May 5;11:871-874. doi: 10.2147/OPTH.S135112. eCollection 2017.
To evaluate the efficacy of combination therapy of a single intrastromal injection of amphotericin B and topical fluconazole in resistant cases of fungal keratitis, and also topical amphotericin B as monotherapy in terms of the duration of the recovery period and toxic drug effects.
This retrospective 2-year study reviewed 68 cases of unilateral fungal keratitis diagnosed by clinical features and positive laboratory culture results. Forty-one cases were resistant and did not respond to monotherapy with an antifungal agent. Thus, they were treated with a single intrastromal injection of amphotericin B in addition to topical fluconazole as combined antifungal therapy, representing group A. Twenty-seven cases were treated with topical amphotericin B as antifungal monotherapy, representing group B. Topical atropine 1% and different antibiotic eye drops were added to the antifungal agents in both groups. Follow-up of patient records was performed monitoring cure rate, duration of recovery period, and toxic drug effects such as pain, burning sensation, and corneal melting.
The results revealed that group A, treated with combination therapy, showed recovery of 34 cases (82.9%) with a mean duration of 24±6.42 days, significantly different from group B which showed recovery of 16 cases (59.3%) with a mean duration of 39.66±13.6 days. Group A also showed less manifestation of drug toxicity than group B.
Combined intrastromal injection of amphotericin B and topical fluconazole can provide a good modality in the treatment of resistant cases of fungal keratitis, exhibiting highly potent antifungal effects, shorter recovery period, and reduced corneal toxicity.
评估两性霉素B单次基质内注射联合局部使用氟康唑治疗真菌性角膜炎耐药病例的疗效，以及局部使用两性霉素B单一疗法在恢复期时长和药物毒性方面的效果。
这项为期2年的回顾性研究纳入了68例经临床特征及实验室培养结果阳性确诊的单侧真菌性角膜炎病例。41例为耐药病例，对抗真菌药物单一疗法无反应。因此，他们接受了两性霉素B单次基质内注射加局部使用氟康唑的联合抗真菌治疗，为A组。27例接受局部使用两性霉素B单一抗真菌治疗，为B组。两组在抗真菌药物基础上均加用了1%的局部阿托品和不同的抗生素眼药水。对患者记录进行随访，监测治愈率、恢复期时长以及疼痛、烧灼感和角膜溶解等药物毒性反应。
结果显示，接受联合治疗的A组有34例（82.9%）痊愈，平均时长为24±6.42天，与B组有显著差异，B组有16例（59.3%）痊愈，平均时长为39.66±13.6天。A组的药物毒性表现也比B组少。
两性霉素B基质内注射联合局部使用氟康唑可为真菌性角膜炎耐药病例的治疗提供一种良好的方式，具有高效的抗真菌作用、较短的恢复期以及降低的角膜毒性。
