Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, No.251, FuKang Road, Nankai District, 300384, Tianjin, China.
BMC Ophthalmol. 2023 Sep 4;23(1):364. doi: 10.1186/s12886-023-03114-w.
We present six patients who developed Candida keratitis postoperatively. The clinical features, diagnostic testing including in vivo confocal microscopy, and outcomes are presented.
Six patients who developed Candida keratitis following penetrating and endothelial keratoplasty, were referred to Tianjin Medical University Eye Hospital between 2018 to 2021.The diagnosis was established following cultures of either corneal scraping or biopsy. In vivo confocal microscopy examination was also performed to confirm the diagnosis and characterize the morphology, distribution and the depth of Candida spp. All patients were treated with topical voriconazole (VCZ) 1% and natamycin (NTM) 5%. Patients with mid/deep stromal keratitis or interface infection were treated additionally with intrastromal or interface VCZ irrigation (0.05 mg/0.1mL).
The cultures of corneal scrapings (4 cases) or biopsies (2 cases) were all positive for Candida spp. In vivo confocal microscopy examination was positive for fungal elements in five of the six patients. The infection resolved in five of the six patients. The patients' final uncorrected visual acuity (UCVA) ranged from hand movements (HM) to 20/80.
In vivo confocal microscopy is a useful non-invasive clinical technique for confirming the diagnosis of Candida keratitis. Intrastromal and interface irrigated VCZ injections are effective treatment options.
我们报告了 6 例术后发生念珠菌角膜炎的患者。介绍了其临床特征、包括活体共聚焦显微镜检查在内的诊断检测以及结局。
2018 年至 2021 年期间，6 例在穿透性和内皮性角膜移植术后发生念珠菌角膜炎的患者被转诊至天津医科大学眼科医院。通过角膜刮片或活检培养来确立诊断。也进行了活体共聚焦显微镜检查以确认诊断，并对念珠菌属的形态、分布和深度进行特征描述。所有患者均接受了局部伏立康唑（VCZ）1%和那他霉素（NTM）5%治疗。对于中/深层基质角膜炎或界面感染的患者，还额外接受了基质内或界面 VCZ 冲洗（0.05mg/0.1mL）。
4 例患者的角膜刮片或 2 例患者的活检培养均为念珠菌属阳性。6 例患者中的 5 例活体共聚焦显微镜检查呈阳性，存在真菌成分。6 例患者中有 5 例感染得到了缓解。患者的最终未矫正视力（UCVA）范围为手动（HM）至 20/80。
活体共聚焦显微镜是一种有用的非侵入性临床技术，可用于确认念珠菌角膜炎的诊断。基质内和界面冲洗 VCZ 注射是有效的治疗选择。
