Shah Ankit, Mauger Thomas
Cornea and External Disease Service, Department of Ophthalmology, Ohio State University College of Medicine, Columbus, Ohio.
Digit J Ophthalmol. 2017 Sep 14;23(3):75-77. doi: 10.5693/djo.02.2017.04.001. eCollection 2017.
We describe our experience managing a case of fungal keratitis in a 71-year-old immunocompetent woman. Intracameral cultures isolated , a dimorphic commensal microbe with limited pathogenicity, in an immune competent patient. Repeated corneal cultures for bacteria and fungus were negative. Initial broad-spectrum topical fortified antibiotics were eventually escalated to include topical natamycin and voriconazole and oral voriconazole. The patient underwent emergent corneal transplantation, but recurrent infection eventually required anterior chamber washout and intracameral injection of amphotericin B. A combination of topical, systemic, intracameral administration of voriconazole, intracameral administration of amphotericin B, anterior chamber washout, and penetrating keratoplasty were required to clear the infection.
我们描述了我们处理一名71岁免疫功能正常女性真菌性角膜炎病例的经验。前房培养分离出一种致病性有限的双相共生微生物，该患者免疫功能正常。多次进行的角膜细菌和真菌培养均为阴性。最初使用的广谱局部强化抗生素最终升级为包括局部那他霉素和伏立康唑以及口服伏立康唑。患者接受了急诊角膜移植，但反复感染最终需要进行前房冲洗和前房注射两性霉素B。需要联合局部、全身、前房内给予伏立康唑、前房内给予两性霉素B、前房冲洗和穿透性角膜移植来清除感染。
