国际眼科纵览 ›› 2022, Vol. 46 ›› Issue (3): 253-260.doi: 10.3760/ cma.j.issn.1673-5803.2022.03.011

• 综述 • 上一篇    下一篇

真菌性角膜炎的治疗

高宁,杨瑞波   

  1. 天津医科大学眼科医院 眼视光学院 眼科研究所 国家眼耳鼻喉疾病临床医学研究中心天津市分中心 天津市视网膜功能与疾病重点实验室 300384
  • 收稿日期:2021-12-17 出版日期:2022-06-22 发布日期:2022-06-22
  • 通讯作者: 杨瑞波,Email:yangruibo771@163.com
  • 基金资助:
    天津市自然科学基金(19JCYBJC25700);天津市滨海新区卫生健康委员会科技项目(2019BWKZ008);天津市临床重点学科(专科)建设项目(TJLCZDXKM002);北京白求恩公益基金会(BJ-GY2021008J)

The treatment of fungal keratitis

Gao Ning, Yang Ruibo   

  1. Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjing 300384, China
  • Received:2021-12-17 Online:2022-06-22 Published:2022-06-22
  • Contact: Yang Ruibo, Email: yangruibo771@163.com
  • Supported by:
    Natural Science Foundation of Tianjin City (19JCYBJC25700); Science and Technology Project of Tianjin Binhai New District Health Commission (2019BWK2008); Tianjin Clinical Key Discipline Project (TJLCZDXKM002); Beijing Bethune Charitable Foundation (BJ-GY2021008J)

摘要: 近年来,医学及相关学科的发展为真菌性角膜炎(fungal keratitis,FK)的治疗提供了新的前景。药物治疗方面主要围绕研发安全有效的抗真菌药物如丙烯胺类、棘白菌素类、抗菌肽及其衍生物,FK免疫机制的深入研究为免疫抑制剂的应用提供了理论基础,此外,眼部药物递送系统与抗真菌药物的联合使用可促进药物进入角膜发挥作用,其疗效在FK动物模型得到验证,部分复合体如氟康唑脂质体在临床使用后效果良好。手术治疗方面,早期手术、病原菌以水平生长为主、病灶浸润深度浅、联合使用有效抗真菌药对提高板层角膜移植手术的成功率具有重要意义,同时角膜基质注药、角膜胶原交联、准分子激光术等手术技术在感染早期、病灶浸润较浅或单独使用药物治疗效果欠佳者的FK患者中均突显出各自的优势。不同作用机制的药物及各类术式的联合,可为FK良好预后提供重要保障。(国际眼科纵览,2022, 46:253-260)

关键词: 真菌性角膜炎, 抗真菌制剂, 手术, 联合治疗

Abstract: In recent years, the development of medicine and related disciplines has provided a new prospect for the treatment of fungal keratitis (FK). In terms of drugs, it mainly focuses on the development of safe and effective antifungal drugs such as acrylamide, echinocandins, antimicrobial peptides and their derivatives. The study of FK immune mechanism provides a theoretical basis for the application of immunosuppressants. In addition, the combine of ocular drug delivery system and antifungal drugs can promote the corneal permeation of drugs, and the effectiveness has been verified by FK animal model, some complexes, such as fluconazole liposomes, have good effects. In terms of FK surgery, early surgery,  the pathogen mainly growing horizontally, slight infiltration with effective antifungal drugs are of great significance to improve the success rate of lamellar keratoplasty. At the same time, intrastromal injection of antifungal drug, corneal collagen cross-linking technology, excimer laser technology highlight their respective advantages in FK patients with early infection, slight infiltration or no response to antifungal drug. In the future, with the continuous development and application of effective antifungal drugs for ophthalmic preparations, the improvement of corneal surgery technology and the cooperation of multiple disciplines, the therapeutic effect and prognosis of FK are expected to be greatly improved.(Int Rev Ophthalmol, 2022, 46: 253-260)

Key words: fungal keratitis, antifungal agents, surgery, combined therapy