Objective To observe the clinical efficacy of injection of different anti-fungal drugs in corneal stroma for the treatment of fungal keratitis caused by injury due to chestnut stab.Methods Eightythree eyes of 83 cases of fungal keratitis caused by chestnut were randomly divided into three groups.The etiological results of all cases were obtained by fungal culture.After corneal debridement,patients in group A,group B and group C received the injection of fluconazole,amphotericin B and voriconazole in corneal stroma respectively on the basis of using 5％ natamycin eye drops.The effect of the treatments for the three groups were observed.Results The first pathogenic bacteria was the Alternaria of the pathogen accounting for 34.9％ (29 cases),followed by Fusarium 30.1％ (25 cases) and Aspergillus 15.7％ (13 cases).The cure rates of three groups were 70.3％ (19/27),76％ (18/25) and 90.3％ (28/31) respectively.The average cure rate of group C was higher than that of group A and B,and the differences were statistically significant (x2 =5.349,4.895;P =0.021,0.027).There was no statistically significant difference in the cure rate between group A and B (x2 =0.027,P =0.869).The cure time of group C was (22.48 ± 8.36) d which was shorter than that of group A (27.40 ± 3.97) d and group B (28.76 ± 5.12) d and the differences were statistically significant (t =2.544,3.006;P =0.014,0.004).There was no statistically significant difference in the cure time between group A and B (t =1.069,P =0.290).Two cases in group B suffered eye irritation symptoms,and the symptom disappeared after the use of Diclofenac Sodium eye drops for two days.No adverse reactions during the treatment occurred in the remaining cases.All cases were followed up for 1-3 months and no puncture tract scar formed or no recurrent case happened.Conclusion The main pathogenic bacteria of fungal keratitis by chestnut stab are Alternaria and Fusarium.The injection of fluconazole,amphotericin B and voriconazole respectively in corneal stroma can bring better curative effect,especially the voriconazole and for severe cases the curative effect of voriconazole is better than that of fluconazole and amphotericin B.%目的 观察角膜基质内注射不同的抗真菌药物治疗板栗刺损伤所致真菌性角膜炎的临床效果.方法 将板栗刺损伤所致真菌性角膜炎83例(83眼)随机分为3组.所有病例通过真菌培养获取病原学结果,并在角膜清创,5％那他霉素滴跟液滴眼治疗的基础上分别采用氟康唑(A组),二性霉素B(B组),伏立康唑(C组)行角膜基质内注射.观察3组病例的治疗效果.结果 首位致病菌为链格霉菌,29例,占34.9％;其次为镰刀菌,25例,占30.1％和曲霉菌13例,占15.7％.3组治愈率依次为70.3％ 、76.0％ 、90.3％,C组的治愈率高于A、B两组,差异有统计学意义(x2=5.349、4.895,P=0.021,0.027).A组和B组治愈率比较差异无统计学意义(x2=0.027,P=0.869);C组的平均治愈时间为(22.48±8.36)d,短于A组的(27.40±4.97)d和B组的(28.76±5.12)d,差异均有统计学意义(t=2.544、3.006,P=0.014,0.004),A、B两组的治愈时间比较差异无统计学意义(t=1.069,P=0.290).B组有2例出现注射后眼部刺激症状,经双氯芬酸钠滴眼液滴眼,2d后症状消失,其余病例治疗期间无不良反应.所有病例随访1～3个月,无穿刺道瘢痕形成,治愈者无复发.结论 板栗刺损伤所致真菌性角膜炎的主要致病菌是链格霉菌和镰刀菌,角膜基质内分别注射氟康唑、二性霉素B、伏立康唑均取得较好的疗效,伏立康唑的疗效优于氟康唑和二性霉素B.
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