真菌性角膜溃疡早期诊断及联合药物治疗的临床观察
摘要
目的:探讨真菌性膜溃疡的早期诊断方法及联合药物治疗的效果。方法:收集2017年4月-2018年3月在笔者所在医院经药物治疗的真菌性角膜溃疡患者19例,采用角膜刮片KOH湿片镜检进行早期诊断,联合2～3种抗真菌药物治疗,根据病情调整用药并观察治疗效果。结果:19例真菌性角膜溃疡患者中,18例镜检发现真菌菌丝和/或孢子,13例真菌培养阳性;治愈18例,抗真菌药物治疗3～5 d开始起效,疗程14～56 d,平均(28.5±10.6)d,无效1例。结论:角膜刮片KOH湿片镜检是真菌性角膜溃疡早期诊断的有效方法;联合抗真菌药物治疗对发病早期、病情较轻的患者效果好。
引文
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[2]钟文贤,谢立信,史伟云,等.真菌性角膜炎654例感染谱分析[J].中华医学杂志,2006,92(24):1681-1685.
[3]张伟宏,张伟宏,王丽娅,等.真菌性角膜炎的早期诊断技术[J].医学与哲学,2009,30(6):65-66,72.
[4]Singh K.Spectrum of Fungal Keratitis in North India.[J].Cornea,2005,24(1):8-15.
[5]Bharathi M J,Ramakrishnan R,Vasu S,et al.Epidemiological characteristics and laboratory diagnosis of fungal keratitis.A three-year study.[J].Indian Journal of Ophthalmology,2003,51(4):315-321.
[6]Sharma S,Kunimoto D Y,Gopinathan U,et al.Evaluation of corneal scraping smear examination methods in the diagnosis of bacterial and fungal keratitis:a survey of eight years of laboratory experience.[J].Cornea,2002,21(7):643-647.
[7]王丽娅,张月琴,王印其,等.中国三地区真菌性角膜病致病菌种的调查[J].中华眼科杂志,2000,51(2):138-140.
[8]Caretti L,Babighian S,Rapizzi E,et al.Fungal Keratitis Following Deep Lamellar Keratoplasty[J].Semin Ophthalmol,2011,26(1):5-33.
[9]中华医学会眼科学分会角膜病学组.感染性角膜病临床诊疗专家共识(2011年)[J].中华眼科杂志,2012,63(1):72-75.
[10]Terrence P O’Brien.THERAPY OF OCULAR FUNGAL INFECTIONS[J].Ophthalmology Clinics of North America,1999,12(1):33-50.
[11]谢立信,史伟云.角膜病学[M].北京:人民卫生出版社,2007:280-281.
[12]张俊杰,谢雷克,陈祖基,等.氟康唑眼液滴眼的眼内药代动力学实验研究[J].中华眼科杂志,2002,53(2):47-50.
[13]Prajna N V,Krishnan T,Mascarenhas J,et al.Predictors of outcome in fungal keratitis[J].Eye,2012,26(9):1226-1231.