Svetozarskiy S N, Andreev A N, Shcherbakova S V
Volga District Medical Centre, Federal Medical and Biological Agency, 2 Nizhnevolzhskaya embankment, Nizhny Novgorod, Russian Federation, 603001.
Vestn Oftalmol. 2019;135(4):98-102. doi: 10.17116/oftalma201913504198.
The article presents a case of fungal keratitis after penetrating keratoplasty (PKP). A 35-years old patient had previously undergone surgical removal of an intraocular foreign body and developed chronic keratouveitis and epithelial-endothelial corneal dystrophy. PKP and early postoperative period were uneventful. The patient was frequently monitored with anterior segment photos. Two weeks later, fungal keratitis occurred on the edge of the donor flap. Direct microscopic evaluation revealed fungus spores and filaments, but growth of fungi in culture was negative. Instillation of steroids and antibiotics was discontinued, specific therapy included fluconazole and amphotericin B. Despite the ongoing treatment, keratitis has repeatedly recurred, and infiltrates were scraped. Topical and systemic voriconazole was administered instead of fluconazole in combination with regular scarification. After 3 weeks of treatment with voriconazole, stable corneal epithelialization was achieved and the cornea has restored its transparency. During 1.5 years of the follow-up, keratitis did not reccur; sutures were removed, corrected visual acuity increased to 1.0. Patients who had undergone PKP are at risk of developing fungal keratitis. Frequent monitoring of such patients contributes to early diagnosis of infectious complications. In the absence of officinal antifungal eye drops, specialist has to supply the patient with ex tempore antimycotic agents and change the treatment according to its effectiveness in each specific case.
本文介绍了一例穿透性角膜移植术（PKP）后发生真菌性角膜炎的病例。一名35岁患者此前接受了眼内异物手术切除，并发展为慢性角膜葡萄膜炎和上皮-内皮角膜营养不良。PKP及术后早期过程顺利。通过眼前节照相术对患者进行频繁监测。两周后，在供体角膜瓣边缘发生真菌性角膜炎。直接显微镜检查发现真菌孢子和菌丝，但培养中真菌生长呈阴性。停用类固醇和抗生素滴眼液，特异性治疗包括氟康唑和两性霉素B。尽管持续治疗，角膜炎仍反复复发，并对浸润灶进行刮除。改用伏立康唑局部和全身给药替代氟康唑，并定期进行清创。伏立康唑治疗3周后，角膜上皮实现稳定愈合，角膜恢复透明。在1.5年的随访期间，角膜炎未复发；拆除缝线，矫正视力提高到1.0。接受PKP的患者有发生真菌性角膜炎的风险。对此类患者进行频繁监测有助于早期诊断感染性并发症。在没有药用抗真菌滴眼液的情况下，专科医生必须为患者临时提供抗真菌药物，并根据每个具体病例的疗效调整治疗方案。
