Rosa R H, Miller D, Alfonso E C
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, FL 33136.
Ophthalmology. 1994 Jun;101(6):1005-13. doi: 10.1016/s0161-6420(94)31225-5.
To review the clinical experience with fungal keratitis in south Florida over a 10-year period.
One hundred twenty-five cases of fungal keratitis were identified in the microbiology laboratory records between January 1982 and January 1992. The medical record of each patient was reviewed.
The most commonly associated risk factor was trauma (44%). Fungal keratitis developed in five patients using extended wear contact lenses and one patient wearing a therapeutic bandage contact lens. Clinical features included irregular, feathery margins (62%), a dry, rough texture (47%), and satellite lesions (41%). An initial positive culture was obtained in 90% of patients, with a majority of cultures becoming positive within 48 hours. The Fusarium sp accounted for 62% of the isolates, with Fusarium oxysporum being the most commonly isolated organism. New fungal isolates include Candida parapsilosis, Aspergillus terreus, Candida tropicalis, and Trichosporon beigellii. Natamycin 5% suspension was the initial antifungal agent used for 91% of the patients, with an average duration of treatment of 38 days. Twenty-five patients were treated with oral ketoconazole for a median duration of 2 weeks, in addition to topical antifungal therapy. Thirty-four patients (27%) required a penetrating keratoplasty. Six patients had recurrence of fungal keratitis after penetrating keratoplasty.
Trauma, including contact lens wear, is the most commonly associated risk factor. The fungal organisms can be readily identified in culture. F. oxysporum is the most common organism, with new isolates identified. The mainstay of therapy is topical natamycin with the increasing use of imidazoles.
回顾佛罗里达州南部10年间真菌性角膜炎的临床经验。
在1982年1月至1992年1月间的微生物实验室记录中确定了125例真菌性角膜炎病例。对每位患者的病历进行了回顾。
最常见的相关危险因素是外伤（44%）。5例使用长戴型隐形眼镜的患者和1例佩戴治疗性绷带隐形眼镜的患者发生了真菌性角膜炎。临床特征包括边缘不规则、呈羽毛状（62%）、质地干燥粗糙（47%）和卫星灶（41%）。90%的患者初始培养呈阳性，大多数培养物在48小时内呈阳性。镰刀菌属占分离菌株的62%，尖孢镰刀菌是最常分离出的菌种。新的真菌分离株包括近平滑念珠菌、土曲霉、热带念珠菌和白吉利丝孢酵母。5%的那他霉素悬液是91%患者最初使用的抗真菌药物，平均治疗时间为38天。除局部抗真菌治疗外，25例患者接受了口服酮康唑治疗，中位治疗时间为2周。34例患者（27%）需要进行穿透性角膜移植术。6例患者在穿透性角膜移植术后发生真菌性角膜炎复发。
外伤，包括佩戴隐形眼镜，是最常见的相关危险因素。真菌可在培养中轻易鉴定。尖孢镰刀菌是最常见的菌种，且鉴定出了新的分离株。治疗的主要方法是局部使用那他霉素，同时咪唑类药物的使用也在增加。
