Abstract
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 Eighty-three 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 (χ2=5.349, 4.895; P=0.021, 0.027). There was no statistically significant difference in the cure rate between group A and B (χ2=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. Key words: Keratitis, fungal; Chestnut stab; Etiological examination; Antifungal drugs; Injection, in corneal stroma
Published Version
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