Sun Yajie, Sun Zhuo, Chen Yukai, Deng Guohua
The Third People's Hospital of Changzhou, Changzhou, China.
J Ophthalmol. 2018 Feb 19;2018:1875627. doi: 10.1155/2018/1875627. eCollection 2018.
To analyze the therapeutic effects of corneal debridement combined with intrastromal voriconazole in recalcitrant fungal keratitis.
This is a retrospective study. Fourteen patients with recalcitrant fungal keratitis were treated by corneal debridement combined with intrastromal voriconazole (50 g/0.1 ml). This paper reviews and analyzes the patients' basic state, surgical intervention, medicinal treatment, and outcomes.
The mean sizes of infiltration and ulcer were (5.54 ± 1.32)mm and (3.46 ± 1.03)mm, respectively, and the mean depth was (315.43 ± 57.72)m. Twelve of the patients had satellite lesion, and 2 suffered hypopyon. After intrastromal voriconazole, the size of infiltration decreased significantly to (4.32 ± 1.10)mm ( < 0.001), but there was no significant change in ulcer size ((3.36 ± 0.92)mm, = 0.082). Thirteen patients were cured after corneal debridement. The mean healing time was (15.38 ± 7.38) days. Excluding one cured patient with optic nerve atrophy and one patient for whom the treatment failed, the mean best-corrected visual acuity after healing was (0.23 ± 0.18)LogMAR, a significant improvement compared to pretreatment (0.87 ± 0.57(LogMAR), = 0.01). The mean corneal astigmatism was (1.3 ± 1.6)D of 12 cured patients after healing and (1.0 ± 0.7)D at final follow-up, and there was no significant difference ( = 0.374).
Corneal debridement combined with intrastromal voriconazole is a secure and effective treatment for recalcitrant fungal keratitis.
分析角膜清创联合基质内注射伏立康唑治疗难治性真菌性角膜炎的疗效。
这是一项回顾性研究。14例难治性真菌性角膜炎患者接受了角膜清创联合基质内注射伏立康唑（50 g/0.1 ml）治疗。本文回顾并分析了患者的基本情况、手术干预、药物治疗及治疗结果。
浸润灶和溃疡灶的平均大小分别为(5.54±1.32)mm和(3.46±1.03)mm，平均深度为(315.43±57.72)m。12例患者有卫星灶，2例有前房积脓。基质内注射伏立康唑后，浸润灶大小显著减小至(4.32±1.10)mm（P<0.001），但溃疡灶大小无显著变化（(3.36±0.92)mm，P=0.082）。13例患者经角膜清创后治愈。平均愈合时间为(15.38±7.38)天。排除1例治愈后出现视神经萎缩的患者和1例治疗失败的患者，愈合后的平均最佳矫正视力为(0.23±0.18)LogMAR，与治疗前（0.87±0.57(LogMAR)，P=0.01）相比有显著改善。12例治愈患者愈合后的平均角膜散光为(1.3±1.6)D，末次随访时为(1.0±0.7)D，差异无统计学意义（P=0.374）。
角膜清创联合基质内注射伏立康唑是治疗难治性真菌性角膜炎的一种安全有效的方法。
