Operation Combined With Liposomal Amphotericin B Intraocular Injection Treating Refractory Keratomycosis

Abstract

Objective To To evaluate the efficacy of operation combined with amphotericin B injection in the keratomycosis which not responding to conventional antifungal therapy.Methods Records of 64 patients who were clinical diagnosed with fungal keratitis from November, 2005 to June, 2007 were retrospectively reviewed.All patients did not respond to initial treatment with topical and intravenous fluconazole, 34 cases (34 eyes) of 64 patients had hypopyon, and 18 cases (18 eyes)with secondary glaucoma, 12 cases (12eyes) with endophthalmitis, 9 eyes related with anterior 1/2 vitreous, 3 eyes related with posterior segment.All patients received operation combined with Liposomal amphoteriein B intraocular injection.Results Sixteen cases were carried out modified conjunctival flap microsurgery, 39 cases were carried out penetrative keratoplasty, 9 cases were carried out anterior segment reconstruction surgery.Among 34 eyes, visual acuity was improved in 26 eyes, 8 eyes did not respond which include 2 eyes with keratomycosis that gived up treatment, 3 eyes with hypopyon, and 3 eyes with endophthalmitis.Conclusions Surgery combined with liposomal amphotericin B treatment of severe fungal corneal ulcers is the one effective treatment method.Better clinical efficacy can be achieved, may shorten the course, save the patient eye.Early and rapid diagnosis is an important prerequisite for effective treatment of fungal corneal ulcer. Key words: Amphotericin B liposome; Operation; fungal corneal ulcer