经玻璃体腔内注射药物联合玻璃体切割术治疗真菌性眼内炎

摘要

目的：研究经玻璃体腔内注射伏立康唑及两性霉素B 脂质体联合玻璃体切割术治疗真菌性眼内炎的效果。　　方法：选取2014-09/2016-09本院眼科接受治疗的感染烟曲霉菌的真菌性眼内炎患者27例54眼为研究对象，随机分为对照组、研究1组、研究2组三组，每组9例。在行玻璃体切割术后，对三组患者进行药物敏感度实验，检测药物为两性霉素B脂质体和伏立康唑。之后对三组患者都应用伏立康唑口服，用阿托品膏散瞳，并且每天换药，另外对研究1组和研究2组患者的玻璃体腔内分别注入伏立康唑溶液和两性霉素B脂质体溶液。术后观察前房炎症情况、角膜混浊程度、玻璃体混浊情况和视力恢复情况。结果：烟曲霉菌对两性霉素B脂质体和伏立康唑均敏感。三组患者术后不同时间角膜混浊情况的比较：除术后1d对照组分别与研究1组和研究2组差异无统计学意义外(P>0.05)，其余术后时间比较差异均有统计学意义(P0.05)。三组患者术后不同时间房水闪辉情况的比较：除术后1d对照组分别与研究1组和研究2组差异无统计学意义(P>0.05)，其余术后时间比较差异均有统计学意义(P0.05)。三组患者术后不同时间玻璃体混浊情况的比较：对照组与研究1组除术后1d比较无统计学意义外，其余术后时间均有统计学意义(P0.05)。结论：经玻璃体内注射伏立康唑和两性霉素B脂质体联合玻璃体切割术可以有效地治疗真菌性眼内炎，与两性霉素B脂质体相比，伏立康唑对治疗早期和中期的真菌性眼内炎效果较好。%·AIM: To study the intravitreal injection of voriconazole and liposomal amphotericin B combined with vitrectomy on treatment of fungal endophthalmitis. ·METHODS: Selection of 27 cases(54 eyes) with fungal endophthalmitis caused by Aspergillus fumigatus infection from September 2014 to September 2016 in our hospital to accept the treatment were as the research objects. The 27 patients were randomly divided into control group and study group 1, study groups 2, each group of 9 patients. After vitrectomy, drug sensitivity test of three groups, drug testing for liposomal amphotericin B and voriconazole, were taken. After the application of oral voriconazole for three groups of patients with atropine ointment, and daily dressing, patients in study group 1 and 2 received intravitreal injected of voriconazole and liposomal amphotericin B respectively. The degree of corneal opacity, vitreous opacity and visual acuity were observed after operation. · RESULTS: Aspergillus fumigatus were sensitive to amphotericin B and voriconazole. Comparison of corneal opacity: at 1d after operation, the differences between control group with study group 1 and 2 were not significant (P>0. 05); the differences on the other time points were significant (P 0. 05 ). Comparison of aqueous flare: at 1d after operation, the differences between control group with study group 1 and 2 were not significant(P>0. 05); the differences on the other time points were significant ( P0. 05). Comparison of vitreous body opacity: except for at 1d after operation, the difference between control group and study group 1 were significant ( P0. 05), except for at 6d after operation. ·CONCLUSION:Intravitreal injection of voriconazole and liposomal amphotericin B combined with vitrectomy can be an effective treatment for fungal endophthalmitis. Compared with liposomal amphotericin B, voriconazole is better for early and middle stage of fungal endophthalmitis.