Sharma Namrata, Sahay Pranita, Maharana Prafulla K, Singhal Deepali, Saluja Gunjan, Bandivadekar Pooja, Chako Jacob, Agarwal Tushar, Sinha Rajesh, Titiyal Jeewan S, Satpathy Gita, Velpandian Thirumurthy
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Cornea. 2019 Feb;38(2):141-145. doi: 10.1097/ICO.0000000000001781.
To evaluate the efficacy of the topical, systemic and targeted therapy (TST) protocol in management of fungal keratitis.
All cases of treatment-naive smear- or culture-proven fungal keratitis presenting between June 2013 and May 2017 were recruited. The TST protocol included initial treatment with topical natamycin 5% with addition of oral ketoconazole or voriconazole in ulcers with size >5 mm, depth >50%, or impending perforation. Topical voriconazole 1% was included in case of poor response at 7 to 10 days. Intrastromal or intracameral antifungal injections were administered in case of poor response to combination therapy. Penetrating keratoplasty was performed in case of poor response to any of the regimen.
The study included 223 cases of fungal keratitis with a mean age of 43.6 ± 15.3 years and a male-to-female ratio of 1.8:1. The mean area of the ulcer and infiltrate at presentation was 25.52 ± 19 and 25.7 ± 14.4 mm, respectively. Corrected distance visual acuity at presentation was 2.05 ± 0.43 logMAR that improved to 1.6 ± 0.4 logMAR at 3 months. Fusarium (42.2%) was the most common microorganism isolated, followed by Aspergillus (32.8%). The mean healing time was 41.5 ± 22.2 days, with a final scar size of 14.6 ± 8.2 mm. The treatment success rate with the TST protocol was 79.8%. Corneal perforation developed in 7% of cases (n = 15), and keratoplasty was performed for 20.2% of cases (n = 45).
The TST protocol provides a stepwise treatment algorithm for management of cases of fungal keratitis with varying severity.
评估局部、全身及靶向治疗（TST）方案在真菌性角膜炎治疗中的疗效。
纳入2013年6月至2017年5月间初治的涂片或培养证实的真菌性角膜炎病例。TST方案包括初始用5%那他霉素局部治疗，对于溃疡面积>5mm、深度>50%或即将穿孔的患者加用口服酮康唑或伏立康唑。若7至10天反应不佳，则加用1%伏立康唑局部治疗。若联合治疗反应不佳，则行基质内或前房内抗真菌注射。若对任何一种治疗方案反应不佳，则行穿透性角膜移植术。
该研究纳入223例真菌性角膜炎患者，平均年龄43.6±15.3岁，男女比例为1.8:1。初诊时溃疡和浸润的平均面积分别为25.52±19和25.7±14.4mm。初诊时矫正远视力为2.05±0.43 logMAR，3个月时改善至1.6±0.4 logMAR。分离出的最常见微生物为镰刀菌（42.2%），其次是曲霉菌（32.8%）。平均愈合时间为41.5±22.2天，最终瘢痕大小为14.6±8.2mm。TST方案的治疗成功率为79.8%。7%的病例（n = 15）发生角膜穿孔，20.2%的病例（n = 45）行角膜移植术。
TST方案为不同严重程度的真菌性角膜炎病例提供了一种逐步治疗算法。
