Background Fungal keratitis can cause serious damage to visual function of corneal infective disease,which is more difficult to treat.In recent years,injecting antifungal drugs to the corneal stroma not only enrich the treatment of the disease,but also achieve good clinical effects.Correctly selecting drug kinds and drug concentration can improve the cure rate,and reduce adverse reactions after treatment,but the related research is rare.Objective This study was to observe the clinical effects of corneal stroma fluconazole injection with different concentration for the treatment of fungal keratitis.Methods Prospective study was performed.One hundred and two patients (102 eyes) diagnosed as fungal keratitis were included from May 2012 to January 2015 in Jizhong Energy Xingtai Mining General Hospital.The patients were randomly divided into 3 groups,The eyedrop treatment group (29 eyes) received 0.5％ fluconazole eyedrops and 5％ natamycin eyedrops treatment.The 0.1％ fluconazole group (35 eyes) and 0.2％ fluconazole group (38 eyes) received 0.1％ and 0.2％ fluconazole corneal stroma injection after eyedrop treatment,respectively.Each group underwent potassium hydroxide wet examination and fungal cultures.The curative effect and adverse reactions were observed.Results Fusarium 41.2％ (42/102),Aspergillus 21.6％ (22/102)and Alternaria mold 17.6％ (18/102) ranked the top three pathogenic species.The distribution of pathogenic fungus among the 3 groups were significantly different (x2 =3.763,P＞0.05).The cure rate of eyedrop treatment group was 44.8％ (13/49),which was significantly lower than 0.1％ fluconazole group (74.3％,26/35) and 0.2％ fluconazole group (81.6％,31/38) (x2 =5.782,9.854;both at P＜0.05).The cure rate was significantly different between 0.1％ fluconazole group and 0.2％ fluconazole group (x2=0.566,P＞0.05).The average cure time of eyedrop treatment group,0.1％ fluconazole group and 0.2％ fluconazole group were (36.28 ± 10.39),(29.14± 7.86) and (21.34 ± 8.57) days,respectively,with a significant difference among the three groups (F =5.336,P=0.006).The acuity of vision was significantly increased after treatment in the 0.1％ fluconazole group and 0.2％ fluconazole group (t =3.009,4.695;both at P ＜ 0.01).The average number of injection in the 0.1％ fluconazole group was (5.71 ± 2.97) times,which was higher than (5.13 ± 1.80) times in the 0.2％ fluconazole group (t=4.471,P＜0.05).Four cases in 0.2％ fluconazole group with eye irritation were observed.After diclofenac sodium eyedrops treatment,the symptoms of 3 cases were disappeared.One case was cured by conjunctival flap covering method.All the cases were followed up for 1-3 months,no adverse reactions and recurrence was found.Conclusions Corneal stroma fluconazole injection is an effective method for treatment of fungal keratitis.In order to reduce the occurrence of adverse reactions,0.1％ fluconazole injection in corneal stroma is recommend for light fungal keratitis patients;for moderate and heavy fungal keratitis patients,0.2％ fluconazole injection in corneal stroma can be performed after failure of 0.1％ fluconazole treatment.%背景 真菌性角膜炎是严重危害视功能的角膜感染性疾病,其治疗较为棘手.近年来角膜基质内注射抗真菌药物不仅丰富了该病的治疗手段,而且取得了较好的临床效果,正确地选择用药种类和适当的药物浓度不仅可提高真菌性角膜炎的治愈率,还可减少注射后的不良反应,但这方面的研究报道相对较少.目的 观察角膜基质内注射不同浓度氟康唑治疗真菌性角膜炎的疗效. 方法 采用前瞻性病例对照研究,纳入2012年5月至2015年1月在冀中能源邢台矿业集团总医院诊治的102例102眼真菌性角膜炎患者,根据完全随机方法分为3个组,其中点眼治疗组(29眼)给予质量分数0.5％氟康唑和质量分数5％那他霉素滴眼液点眼,0.1％氟康唑组(35眼)和0.2％氟康唑组(38眼)在点眼治疗组治疗基础上再分别给予0.1％和0.2％氟康唑角膜基质内注射.各组患者均行KOH湿片检查和真菌培养,观察各组疗效及不良反应情况.结果 病原菌检测排在前3位的致病菌种分别是镰刀菌41.2％ (42/102)、曲霉菌21.6％(22/102)和链格孢菌17.6％(18/102),各组患者致病菌总体比较差异无统计学意义(x2=3.763,P＞0.05).点眼治疗组的治愈率为44.8％(13/29),明显低于0.1％氟康唑组的74.3％(26/35)和0.2％氟康唑组的81.6％ (31/38),差异均有统计学意义(x2=5.782、9.854,均P＜0.05);0.1％氟康唑组与0.2％氟康唑组治愈率比较差异无统计学意义(x2 =0.566,P＞0.05).点眼治疗组、0.1％氟康唑组和0.2％氟康唑组的平均治愈时间分别为(36.28±10.39)、(29.14±7.86)和(21.34±8.57)d,各组平均治愈时间总体比较,差异有统计学意义(F=5.336,P=0.006).0.1％氟康唑组和0.2％氟康唑组患者治疗后视力较治疗前均有提高,差异均有统计学意义(t=3.009、4.695,均P＜0.01),但点眼治疗组治疗前后视力比较差异无统计学意义(t=1.364,P＞0.05).0.1％氟康唑组的平均注射次数为(5.71±2.97)次,显著高于0.2％氟康唑组的(5.13±1.80)次,两组比较差异有统计学意义(t=4.471,P＜0.05).0.2％氟康唑组有4例注射后出现了较明显的眼部刺激症状,给予双氯酚酸钠滴眼液点眼2d后,3例症状消失,1例症状持续1周不缓解,且角膜感染渐加重,最终经结膜瓣遮盖治疗后痊愈.所有患者随访1～3个月未见不良反应及复发. 结论 角膜基质内注射氟康唑是治疗真菌性角膜炎的有效方法.为减少注射后不良反应,对轻型真菌性角膜炎患者建议首选0.1％氟康唑作为角膜基质内注射用药,中型、重型真菌性角膜炎患者及对0.1％氟康唑角膜基质内注射疗效不佳者可考虑0.2％氟康唑角膜基质内注射.
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