Pak Clara M, Savage Daniel E, Plotnik Ronald, Wozniak Rachel A F
Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Case Rep Ophthalmol. 2022 Jul 14;13(2):550-555. doi: 10.1159/000525156. eCollection 2022 May-Aug.
Bacterial keratitis (corneal infection) caused by more than one organism is rare and exceedingly difficult to treat due to variable antibiotic susceptibilities. Intrastromal injections of antibiotics may be necessary to achieve higher drug concentrations at the site of infection, particularly in the case of deep stromal disease refractory to topical therapy. However, while this approach is increasingly used for fungal keratitis, there is a paucity of the literature regarding the use of intrastromal antibiotics bacterial keratitis. In the current case, an 86-year-old patient presented with a left corneal ulcer with corresponding microbiologic cultures positive for , , and species. The ulcer continued to progress despite maximal topical antibiotic treatment yet demonstrated marked improvement after two intrastromal injections of moxifloxacin administered 2 weeks apart. Polymicrobial keratitis can be particularly challenging to eradicate despite maximal topical antibiotic therapeutics. Intrastromal corneal injections provide a mechanism for drug delivery directly to the site of infection and thus may represent an important alternative in refractory cases.
由多种病原体引起的细菌性角膜炎（角膜感染）很罕见，而且由于抗生素敏感性各异，治疗起来极其困难。对于深部基质疾病，局部治疗效果不佳时，可能需要进行基质内注射抗生素，以在感染部位达到更高的药物浓度。然而，虽然这种方法越来越多地用于真菌性角膜炎，但关于基质内抗生素治疗细菌性角膜炎的文献却很少。在当前这个病例中，一名86岁的患者出现左眼角膜溃疡，相应的微生物培养显示 、 和 菌种呈阳性。尽管进行了最大剂量的局部抗生素治疗，溃疡仍在继续发展，但在相隔两周进行了两次基质内莫西沙星注射后，病情有了明显改善。尽管进行了最大剂量的局部抗生素治疗，多微生物性角膜炎仍可能特别难以根除。角膜基质内注射提供了一种将药物直接输送到感染部位的机制，因此可能是难治性病例的一种重要替代方法。
