中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
CHINESE JOURNAL OF OCULAR TRAUMA AND OCCUPATIONAL EYE DISEASE
2013年
5期
345-348
,共4页
高艳%董晓光%孙士营%李君%刘廷%马修彬
高豔%董曉光%孫士營%李君%劉廷%馬脩彬
고염%동효광%손사영%리군%류정%마수빈
角膜溃疡,真菌性%眼内炎,真菌性%角膜移植%伏立康唑%手术,联合,眼前后段
角膜潰瘍,真菌性%眼內炎,真菌性%角膜移植%伏立康唑%手術,聯閤,眼前後段
각막궤양,진균성%안내염,진균성%각막이식%복립강서%수술,연합,안전후단
Corneal ulcer,fungal%Endophthalmitis,fungal%Corneal transplantation%Voriconazole%Operation,combination,anterior and posterior segments
目的 研究真菌性角膜溃疡继发真菌性眼内炎的有效治疗方法.方法 真菌性角膜溃疡继发真菌性眼内炎4例.入院后使用抗真菌药物静脉滴注及滴眼,或联合伏立康唑玻璃体腔注药(100μg/0.1 ml),效果不佳,于平均72 h内行穿透性角膜移植术联合临时人工角膜下玻璃体切除或硅油取出术,术中及术后行1次或多次伏立康唑玻璃体腔内注射.术后使用伏立康唑静脉滴注和/或滴眼,其中1例联合伏立康唑结膜下注射.结果 4例均成功治愈了角膜及眼内真菌感染,最佳矫正视力分别由术前手动/10 cm、光感、光感、手动/50 cm提高至术后0.8、手动/30 cm、0.05、0.2.除1例中央甘油植片不透明者外,其余患眼均获得有用视力.随访7～9个月,感染未复发.2例接受活性保存的角膜植片者随访中均未发生免疫排斥.结论 临时人工角膜下眼前后段联合手术是治疗真菌性角膜溃疡继发真菌性眼内炎的有效手术方案,以伏立康唑多途径给药治疗该病获得了良好效果.
目的 研究真菌性角膜潰瘍繼髮真菌性眼內炎的有效治療方法.方法 真菌性角膜潰瘍繼髮真菌性眼內炎4例.入院後使用抗真菌藥物靜脈滴註及滴眼,或聯閤伏立康唑玻璃體腔註藥(100μg/0.1 ml),效果不佳,于平均72 h內行穿透性角膜移植術聯閤臨時人工角膜下玻璃體切除或硅油取齣術,術中及術後行1次或多次伏立康唑玻璃體腔內註射.術後使用伏立康唑靜脈滴註和/或滴眼,其中1例聯閤伏立康唑結膜下註射.結果 4例均成功治愈瞭角膜及眼內真菌感染,最佳矯正視力分彆由術前手動/10 cm、光感、光感、手動/50 cm提高至術後0.8、手動/30 cm、0.05、0.2.除1例中央甘油植片不透明者外,其餘患眼均穫得有用視力.隨訪7～9箇月,感染未複髮.2例接受活性保存的角膜植片者隨訪中均未髮生免疫排斥.結論 臨時人工角膜下眼前後段聯閤手術是治療真菌性角膜潰瘍繼髮真菌性眼內炎的有效手術方案,以伏立康唑多途徑給藥治療該病穫得瞭良好效果.
목적 연구진균성각막궤양계발진균성안내염적유효치료방법.방법 진균성각막궤양계발진균성안내염4례.입원후사용항진균약물정맥적주급적안,혹연합복립강서파리체강주약(100μg/0.1 ml),효과불가,우평균72 h내행천투성각막이식술연합림시인공각막하파리체절제혹규유취출술,술중급술후행1차혹다차복립강서파리체강내주사.술후사용복립강서정맥적주화/혹적안,기중1례연합복립강서결막하주사.결과 4례균성공치유료각막급안내진균감염,최가교정시력분별유술전수동/10 cm、광감、광감、수동/50 cm제고지술후0.8、수동/30 cm、0.05、0.2.제1례중앙감유식편불투명자외,기여환안균획득유용시력.수방7～9개월,감염미복발.2례접수활성보존적각막식편자수방중균미발생면역배척.결론 림시인공각막하안전후단연합수술시치료진균성각막궤양계발진균성안내염적유효수술방안,이복립강서다도경급약치료해병획득료량호효과.
Objective To explore treatment methods for fungal endophthalmitis resulting from fungal keratitis.Methods 4 cases diagnosed as fungal endophthalmitis resulting from fungal keratitis were observed.All patients were firstly treated with topical and intravenous antifungal drugs or combination with voriconazole intravitreous injection (100 μg/0.1 ml) after admission to hospital.Then operation of penetrating keratoplasty combined with vitrectomy or silicone oil removal under temporary artificial cornea was performed within about 72 hours for progression of the disease.Intravitreous injection of voriconazole was given once or more intra-and postoperatively.Intravenous and/or topical voriconazole was given postoperatively.One case also received subconjunctival injection of voriconazole.Results All cases got resolution of fungal infection with BCVA improved from HM/10 cm,LP,LP and HM/50 cm to 0.8,HM/30 cm,0.05 and 0.2 respectively.All cases got useful VA except the one with opaque glycerin-cryopreserved graft put in the center.Within 7 ～9 months' follow-up,no recurrent case was observed and the 2 cases with fresh grafts had no immune rejection.Conclusion Combined operation of anterior and posterior segments under temporary artificial cornea and voriconazole delivery in varied pathways were proved to be effective treatment methods for fungal endophthalmitis resulting from keratitis.
