Singh Charul, Mohanty Amrita, Rajagopal Raksheeth N, Ali Md Hasnat, Joseph Joveeta, Bagga Bhupesh
Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2025 Jul 1;73(7):1044-1049. doi: 10.4103/IJO.IJO_2765_24. Epub 2025 Jun 30.
To compare the outcome of adjuvant intrastromal Amphotericin B (ISAMPB) and Voriconazole (ISVCZ) in managing refractory deep stromal fungal keratitis.
We reviewed the records of patients treated between January 2020 and December 2022 for microbiologically confirmed refractory fungal keratitis that had worsened despite treatment with topical Natamycin, with or without oral Ketoconazole. These patients received adjuvant therapy with either intrastromal Amphotericin B (ISAMPB, 5-10 µg/0.1 ml) or intrastromal Voriconazole (ISVCZ, 50 µg/0.1 ml). The demographics, clinical profiles, and outcomes of the ISAMPB and ISVCZ groups were compared, with key outcomes being the proportion of patients achieving clinical resolution and the number of therapeutic keratoplasty procedures performed. A logistic regression model was constructed for multivariate analysis to adjust for potential confounders.
Medical records of 49 patients with refractory fungal keratitis were analyzed: 34 (69.3%) received ISAMPB, and 15 (30.6%) received ISVCZ. The overall mean LogMAR visual acuity was 1.90 ± 0.6, and the infiltrate size averaged 4.28 ± 1.30 mm vertically and 4.3 ± 1.4 mm horizontally. Aspergillus and Fusarium each accounted for 32.3% of ISAMPB patients, and 40% and 20% of ISVCZ patients, respectively. The median time to intrastromal injection was 12 days for ISAMPB and 11 days for ISVCZ. ISAMPB achieved resolution in 53% of cases, while 41.1% required TPK; ISVCZ resolved in 10%, with 86% requiring TPK (P < 0.01). The adjusted odds ratio for ISAMPB response was 21.98 (P = 0.013).
Intrastromal Amphotericin B has been shown to provide better outcomes than Voriconazole in the treatment of deep stromal refractory fungal keratitis.
比较辅助性基质内注射两性霉素B（ISAMPB）和伏立康唑（ISVCZ）治疗难治性深层基质真菌性角膜炎的疗效。
我们回顾了2020年1月至2022年12月期间接受治疗的患者记录，这些患者经微生物学确诊为难治性真菌性角膜炎，尽管使用了局部那他霉素治疗，无论是否联合口服酮康唑，病情仍有恶化。这些患者接受了辅助治疗，分别为基质内注射两性霉素B（ISAMPB，5 - 10μg/0.1ml）或基质内注射伏立康唑（ISVCZ，50μg/0.1ml）。比较了ISAMPB组和ISVCZ组的人口统计学、临床特征和治疗结果，主要结果是达到临床治愈的患者比例和进行治疗性角膜移植手术的次数。构建逻辑回归模型进行多变量分析以调整潜在的混杂因素。
分析了49例难治性真菌性角膜炎患者病历：34例（69.3%）接受ISAMPB治疗，15例（30.6%）接受ISVCZ治疗。总体平均LogMAR视力为1.90±0.6，浸润灶大小垂直平均为4.28±1.30mm，水平平均为4.3±1.4mm。曲霉菌和镰刀菌在ISAMPB组患者中各占32.3%，在ISVCZ组患者中分别占40%和20%。基质内注射的中位时间ISAMPB组为12天，ISVCZ组为11天。ISAMPB组53%的病例病情得到缓解，而41.1%的病例需要进行穿透性角膜移植术（TPK）；ISVCZ组10%的病例病情缓解，86%的病例需要进行TPK（P<0.01）。ISAMPB治疗反应的调整优势比为21.98（P = 0.013）。
在治疗深层基质难治性真菌性角膜炎方面已证明，基质内注射两性霉素B比伏立康唑疗效更好。
