CAJ | 학술논문

目的：探讨板栗刺所致真菌性角膜炎患者的溃疡形态、致病菌属及治疗特点。方法回顾性分析2011年9月-2013年12月收治的14例（14眼）板栗刺所致真菌性角膜炎患者的临床资料，根据溃疡形态分上皮型、基质脓肿型、内皮或前房型，真菌培养获取病原学结果，并根据溃疡类型采用那他霉素＋氟康唑＋伊曲康唑三联抗真菌药物治疗联合溃疡板层清创、两性霉素B角膜基质注射、平衡盐液前房冲洗及两性霉素B前房注射等手术干预措施，观察治疗效果及预后。结果14例患者中10例真菌培养结果阳性，链格霉菌及镰刀霉菌各4例，青霉菌及曲霉菌各1例；溃疡分型：上皮型7例，基质脓肿型2例，内皮或前房型5例；上皮型对三联抗真菌药物治疗敏感，联合溃疡板层清创术治疗后有效率为100％（7/7）；基质脓肿型、内皮或前房型对单纯三联抗真菌药物治疗基本无效，联合两性霉素B基质注射或前房冲洗及两性霉素B前房注射后治疗有效率为85?．7％（6/7）。14例均未见严重并发症。结论板栗刺所致真菌性角膜炎在溃疡形态上具有多样性，致病菌属以链格霉菌和镰刀霉菌为主，临床上根据溃疡类型采取抗真菌药物治疗联合恰当的手术干预可取得良好的治疗效果。
목적：탐토판율자소치진균성각막염환자적궤양형태、치병균속급치료특점。방법회고성분석2011년9월-2013년12월수치적14례（14안）판율자소치진균성각막염환자적림상자료，근거궤양형태분상피형、기질농종형、내피혹전방형，진균배양획취병원학결과，병근거궤양류형채용나타매소＋불강서＋이곡강서삼련항진균약물치료연합궤양판층청창、량성매소B각막기질주사、평형염액전방충세급량성매소B전방주사등수술간예조시，관찰치료효과급예후。결과14례환자중10례진균배양결과양성，련격매균급렴도매균각4례，청매균급곡매균각1례；궤양분형：상피형7례，기질농종형2례，내피혹전방형5례；상피형대삼련항진균약물치료민감，연합궤양판층청창술치료후유효솔위100％（7/7）；기질농종형、내피혹전방형대단순삼련항진균약물치료기본무효，연합량성매소B기질주사혹전방충세급량성매소B전방주사후치료유효솔위85?．7％（6/7）。14례균미견엄중병발증。결론판율자소치진균성각막염재궤양형태상구유다양성，치병균속이련격매균화렴도매균위주，림상상근거궤양류형채취항진균약물치료연합흡당적수술간예가취득량호적치료효과。
Objective To explore the features and treatment of ulcer morphological , pathogenic bacteria of fungal keratitis which is caused by chestnut .Methods From 2011 September to 2013 December, retrospective analysis clinical data of 14 cases (14 eyes) of fungal keratitis which were caused by chestnut , according to the ulcer morphology , they were classi-fied as epithelial type , matrix abscess type , endothelial or anterior chamber type;using of fungal culture to obtain etiological results , and according to the type of the ulcer , natamycin +itraconazole +fluconazole antifungal drug therapy combined with ulcer combined lamellar debridement , amphotericin B intrastromal injection , balanced salt solution for irrigation of anterior chamber and amphotericin B anterior chamber injection operation intervention were performed , and observe the therapeutic effect and prognosis .Results Among the 14 patients, 10 cases with fungal culture positive results , Alternaria fungi and Fu-sarium sp.were found in 4 cases separately, Penicillium and Aspergillus were in 1 case separately; ulcer types: epithelial type in 7 cases, 2 cases of stromal abscess type , 5 cases of endothelial or epithelial type on the anterior chamber;antifungal drug was sensitive for epithelial type , combined with plate layer ulcer debridement treatment , efficiency was 100%(7/7);for stromal abscess type , endothelial or anterior chamber type , simple triple antifungal treatment is ineffective , the effective rate was 85.7%(6/7) in the treatment of B matrix injection or anterior chamber irrigation and amphotericin B after anterior cham -ber injection combined with amphotericin .All 14 cases showed no severe complications .Conclusion The fungal keratitis caused by Chinese chestnut thorns have diversity in ulcers formation;alternaria and fusarium are the main pathogens;on the basis of clinical types of ulcer to take operation and combined with appropriate antifungal treatment can achieve good therapeu -tic effect.