Clinical observation of corneal stroma injection of different concentrations of fluconazole for fungal keratitis

Background

Fungal keratitis can cause serious damage to visual function of corneal infective disease, which is more difficult to treat.In recent years, injecting antifungal drugs to the corneal stroma not only enrich the treatment of the disease, but also achieve good clinical effects.Correctly selecting drug kinds and drug concentration can improve the cure rate, and reduce adverse reactions after treatment, but the related research is rare.

Objective

This study was to observe the clinical effects of corneal stroma fluconazole injection with different concentration for the treatment of fungal keratitis.

Methods

Prospective study was performed.One hundred and two patients (102 eyes) diagnosed as fungal keratitis were included from May 2012 to January 2015 in Jizhong Energy Xingtai Mining General Hospital.The patients were randomly divided into 3 groups, The eyedrop treatment group (29 eyes) received 0.5% fluconazole eyedrops and 5% natamycin eyedrops treatment.The 0.1% fluconazole group (35 eyes) and 0.2% fluconazole group (38 eyes) received 0.1% and 0.2% fluconazole corneal stroma injection after eyedrop treatment, respectively.Each group underwent potassium hydroxide wet examination and fungal cultures.The curative effect and adverse reactions were observed.

Results

Fusarium 41.2% (42/102), Aspergillus 21.6% (22/102) and Alternaria mold 17.6% (18/102) ranked the top three pathogenic species.The distribution of pathogenic fungus among the 3 groups were significantly different (χ²=3.763, P>0.05). The cure rate of eyedrop treatment group was 44.8% (13/49), which was significantly lower than 0.1% fluconazole group (74.3%, 26/35) and 0.2% fluconazole group (81.6%, 31/38) (χ²=5.782, 9.854; both at P<0.05). The cure rate was significantly different between 0.1% fluconazole group and 0.2% fluconazole group (χ²=0.566, P>0.05). The average cure time of eyedrop treatment group, 0.1% fluconazole group and 0.2% fluconazole group were (36.28±10.39), (29.14±7.86) and (21.34±8.57) days, respectively, with a significant difference among the three groups (F=5.336, P=0.006). The acuity of vision was significantly increased after treatment in the 0.1% fluconazole group and 0.2% fluconazole group (t=3.009, 4.695; both at P<0.01). The average number of injection in the 0.1% fluconazole group was (5.71±2.97) times, which was higher than (5.13±1.80) times in the 0.2% fluconazole group (t=4.471, P<0.05). Four cases in 0.2% fluconazole group with eye irritation were observed.After diclofenac sodium eyedrops treatment, the symptoms of 3 cases were disappeared.One case was cured by conjunctival flap covering method.All the cases were followed up for 1-3 months, no adverse reactions and recurrence was found.

Conclusions

Corneal stroma fluconazole injection is an effective method for treatment of fungal keratitis.In order to reduce the occurrence of adverse reactions, 0.1% fluconazole injection in corneal stroma is recommend for light fungal keratitis patients; for moderate and heavy fungal keratitis patients, 0.2% fluconazole injection in corneal stroma can be performed after failure of 0.1% fluconazole treatment.