摘要:
Objective To observe the clinical effects of local point eye antifungal drugs, subconjunctival injection and corneal intrastromal injection in the treatment of fungal keratitis.Methods A clinical case-control study.One hundred and seventy-six cases (176 eyes) with fungal keratitis were referred to Department of Ophthalmology, Xingtai mining group general hospital from September 2010 to December 2014.The patients were randomly divided into three groups, control group (group A, 54 eyes), subconjunctival injection group (group B, 62 eyes), corneal intrastromal injection group (group C, 60 eyes).The group A's patients underwent corneal debridement, 2% iodine tincture cauterization, 5% natamycin eye drops and 0.5% fluconazol eye drops, on this basis, the group B received subconjunctival injection of 0.2% fluconazol, group C were given injection in corneal stroma.The difference of efficacy between the three groups was observed.Results The cure rates of group B and group C were 58.06% and 81.67%, both were significantly higher than group A's 38.89%, compared with the group A, the difference was statistically significant (x2=4.246, 21.95, P <0.05),the difference between group B and group C was statistically significant (x2=8.039, P <0.05).The average cure time in the group B was (30.26±8.44)d and group C was (22.14±9.63)d, which were shorter than the group A's (37.12±11.13)d, the difference was statistically significant (t =3.156, 6.637, P<0.05).The difference between group B and group C was statistically significant (t =4.731, P <0.05).The visual acuity of the three groups was improved after treatment, there was no significant difference in the treatment before and after the treatment of group A (t =1.706, P >0.05), the visual acuity of group B and group C were statistically significant (t =2.943, 4.587, P <0.05).The average number of injection in the group C was (4.88±1.48) and the difference was statistically significant for the (8.77±2.48) times in the group B (t =10.481, P <0.05).There were 3 cases in group C after injection of eye irritation, given Diclofenac Sodium Eye Drops, symptoms disappeared after two days.All the cases were followed up for 1-3 months, no scar formation was found, and no recurrence was found.Conclusions Both subconjunctival injection and corneal intrastromal injection are effective methods for the treatment of fungal keratitis, and the efficacy of the corneal intrastromal injection is better than that of the injection of the conjunctiva.%目的 观察抗真菌药物局部点眼、球结膜下注射和角膜基质内注射治疗真菌性角膜炎的临床疗效.方法 临床病例对照研究.将2010年9月至2014年12月在邢台矿业集团总医院眼科确诊的真菌性角膜炎患者176例(176只眼)随机分为三组,对照组(A组,54只眼),球结膜下注射组(B组,62只眼)和角膜基质内注射组(C组,60只眼).A组行角膜清创,2%碘酊烧灼,5%那他霉素滴眼液和0.5%氟康唑滴眼液点眼治疗,在此基础上B组给予0.2%氟康唑球结膜下注射,C组给予角膜基质内注射,观察各组间的疗效差异.结果 B组和C组的治愈率分别为58.06%和81.67%,均明显高于A组的38.89%,与A组比较差异均有统计学意义(x2=4.246,21.95,P<0.05),B组与C组比较差异有统计学意义(x2=8.039,P<0.05).B组的平均治愈时间(30.26±8.44)d和C组的(22.14±9.63)d短于A组的(37.12±11.13)d,差异有统计学意义(t=3.156,6.637,P<0.05),B组和C组比较差异有统计学意义(t =4.731,P<0.05).三组病例治疗后视力较治疗前有所提高,A组治疗前后比较差异无统计学意义(t =1.706,P>0.05),B组和C组治疗前后视力变化有统计学意义(t=2.943,4.587,P <0.05).C组的平均注射次数(4.88±1.48)次,明显少于B组的(8.77±2.48)次,差异有统计学意义(t =10.481,P<0.05).C组中3例出现注射后眼部刺激症状,给予双氯酚酸钠滴眼液点眼,二日后症状消失.所有病例随访1~3个月未见穿刺道瘢痕形成及治愈者无复发.结论 球结膜下注射和角膜基质内注射都是治疗真菌性角膜炎的有效方法,角膜基质内注射的疗效优于球结膜下注射.