Tseng S H, Tang K Y, Chao S C, Hsu M M
Department of Ophthalmology, National Cheng Kung University Hospital, Tainan, Taiwan R.O.C.
J Formos Med Assoc. 1994 Apr;93(4):300-6.
Keratomycosis, a vision-threatening corneal infection, is a challenge to the ophthalmologist because it is often refractory to medical treatment. Surgical keratectomy may not only debulk the major infectious source but potentiate the intracorneal penetration of the antifungal agents. To evaluate the efficacy of keratectomy in managing the fungal corneal ulcer, three common keratomycosis models, Candida, Fusarium, and Aspergillus keratitis, were established in 46 eyes of 23 rabbits (each group had 14, 16 and 16 eyes respectively). Within each keratitis group, the infected eyes were randomly divided into equally numbered experimental and control subgroups. The eyes of the experimental subgroups underwent therapeutic lamellar keratectomy once the typical fungal corneal infection had developed after inoculation. Following keratectomy, eyes of both the treated and control groups received natamycin eyedrops and were regularly examined biomicroscopically. Our results showed that therapeutic lamellar keratectomy is beneficial in chronic, indolent keratitis, such as Candida and Fusarium keratitis, where it promoted corneal healing and shortened the duration of treatment required. The procedure is a valuable adjunctive measure for antifungal agents in these two types of keratitis. However, acute keratitis of the Aspergillus group did not benefit from keratectomy; in these cases, surgery may actually increase the risk of corneal perforation.
角膜真菌病是一种威胁视力的角膜感染，对眼科医生来说是一项挑战，因为它往往对药物治疗具有耐药性。手术性角膜切除术不仅可以减少主要感染源，还能增强抗真菌药物在角膜内的渗透。为了评估角膜切除术治疗真菌性角膜溃疡的疗效，在23只兔子的46只眼中建立了三种常见的角膜真菌病模型，即白色念珠菌、镰刀菌和曲霉菌角膜炎模型（每组分别有14只、16只和16只眼）。在每个角膜炎组中，将感染的眼睛随机分为数量相等的实验组和对照组。实验组的眼睛在接种后出现典型的真菌性角膜感染时接受治疗性板层角膜切除术。角膜切除术后，治疗组和对照组的眼睛均使用那他霉素滴眼液，并定期进行生物显微镜检查。我们的结果表明，治疗性板层角膜切除术对慢性、难治性角膜炎有益，如白色念珠菌和镰刀菌角膜炎，它能促进角膜愈合并缩短所需的治疗时间。该手术是这两种角膜炎中抗真菌药物的一项有价值的辅助措施。然而，曲霉菌组的急性角膜炎并未从角膜切除术中获益；在这些病例中，手术实际上可能增加角膜穿孔的风险。
