CAJ | 학술논문

目的:报告1例使用5mg/L两性霉素成功治疗难治性真菌性角膜炎的病例.方法:病例报告.结果:女性患者1例,48岁,以右眼红1wk,伴视力下降和角膜混浊2d入院.否认有外伤或异物史.检查发现:右眼视力:6/12,针孔视力:6/18.注射结膜前使眼分泌物保持最少.角膜旁中央区有一全层基质脓肿-形态不规则且伴有卫星病灶及羽状边缘,不伴有上皮缺损,有前房积脓液平.左眼正常.诊断为真菌性角膜炎.尽管在此前患者经历了3wk的局部两性霉素B点眼(1次/2h),那他霉素眼液点眼(1次/4h),但并无病情恢复的迹象.相反12点出现了一个新的更大的基质脓肿病灶.我们应用5mg/L两性霉素B角膜基质注射联合穿透性角膜移植术治疗后溃疡面积明显减少,前房积脓完全消失,没有毒性反应发生.患者干预后2mo视力恢复了正常视力(6/6).结论:使用两性霉素B 5mg/L基质内注射,使用过程安全有效,是一种治疗难治性真菌性角膜炎的理想方法.
목적:보고1례사용5mg/L량성매소성공치료난치성진균성각막염적병례.방법:병례보고.결과:녀성환자1례,48세,이우안홍1wk,반시력하강화각막혼탁2d입원.부인유외상혹이물사.검사발현:우안시력:6/12,침공시력:6/18.주사결막전사안분비물보지최소.각막방중앙구유일전층기질농종-형태불규칙차반유위성병조급우상변연,불반유상피결손,유전방적농액평.좌안정상.진단위진균성각막염.진관재차전환자경력료3wk적국부량성매소B점안(1차/2h),나타매소안액점안(1차/4h),단병무병정회복적적상.상반12점출현료일개신적경대적기질농종병조.아문응용5mg/L량성매소B각막기질주사연합천투성각막이식술치료후궤양면적명현감소,전방적농완전소실,몰유독성반응발생.환자간예후2mo시력회복료정상시력(6/6).결론:사용량성매소B 5mg/L기질내주사,사용과정안전유효,시일충치료난치성진균성각막염적이상방법.
AIM: To report a successful intrastromal injection of amphotericin B 5mg/L in a refractory fungal keratitis.METHODS: An interventional case report RESULTS: A 48-year-old lady presented with history of redness of the right eye for one week duration followed by decrease in vision and corneal opacity for two days. There was no histow of trauma or foreign body. Examination revealed visual acuity of 6/16 with pinhole of 6/12 of the right eye. The conjunctiva was injected with minimal eye discharge. There was a full thickness stromal abscess at the paracentral area of the cornea. It was irregular,feathery margin with few satellite lesions. There was no epithelial defect noted. Hypopyon level was also seen.The left eye was normal. A presumptive diagnosis of fungal keratitis was entertained. Despite three weeks of intensive treatment with topical amphotericin B every 2 hours and natamycin every 4 hours and antibiotic cover,the lesion showed no sign of resolution. It grew larger and a new focal lesion of stromal abscess appeared at the 12 o'clock position. We decided to proceed with an intrastromal injection of amphotericin B 5mg/L in lieu of therapeutic penetrating keratoplasty. The size of the ulcer was substantially reduced with total disappearance of hypopyon. There was no ocular toxicity observed following the intervention. Patient regained her normal visual acuity of 6/6 after 2 months of intervention.CONCLUSION: An intrastromal injection of amphotericin B 5mg/L provides an alternative method of treating refractory fungal keratitis. It is also shown to be an effective and safe procedure with promising results.