真菌性眼内炎是临床上少见的眼内感染疾病。因为其诊断延迟和抗真菌药物的有效性有限，因此真菌性眼内炎常常导致视力严重损害。按照感染性途径，真菌性眼内炎包括内源性和外源性，其中外源性眼内炎常见，进展较快，眼部手术术后感染是常见原因之一。小梁切除术是抗青光眼滤过性手术，是目前手术治疗青光眼的有效方法之一。滤过泡相关性眼内炎是其并发症之一，对患者视功能的损害尤为严重。本文通过回顾1例滤过泡相关性真菌性眼内炎患者的临床病例资料，讨论及分析滤过泡相关性的真菌性眼内炎的危险因素及诊治方法。
Fungal endophthalmitis is a disease which is a rare kind of interocular infection in clinic. Fungal endophthalmitis often results in severe visual impairment because of delayed diagnosis and limited effectiveness of antifungal drugs.Fungal endophthalmitis includes endogenous and exogenous endophthalmitis which is common and progresses rapidly. Postoperative infection is one of the common causes of fungal endophthalmitis. Trabeculectomy is an anti-glaucoma filtering operation, and it is one of the effective methods for glaucoma surgery at present. Glaucoma-filtering bleb infection is one of the complications of trabeculectomy, which can lead to severe visual impairment.In this article, we analyzed and discussed the risk factors, diagnosis and treatment methods about the filtering bleb-associated fungal endophthalmitis.
目的：比较活体共聚焦显微镜和病理检查在角膜后部真菌感染的诊断阳性率，探讨两种检查方法在角膜后部真菌感染诊断中的价值。方法：回顾性病例对照研究。收集2009年11月至2020年12月在青岛眼科医院就诊并进行穿透性角膜移植手术治疗角膜后部真菌感染患者，术前均进行角膜刮片KOH涂片检查和活体共聚焦显微镜检查，术后病变角膜进行病理组织切片、过碘酸-Schiff法(PAS)染色和六亚甲基四胺银法(GMS)染色检查，比较不同检查方法诊断的阳性率。结果：18例角膜后部真菌感染患者角膜刮片KOH涂片均未检查到真菌菌丝，其中有16例患者经活体共聚焦显微镜检查到真菌菌丝(88.9%)，而2例患者在术前活体共聚焦显微镜检查中未查到病原体。术后病理检查PAS染色联合GMS染色，18例患者中18例均可检查到真菌菌丝，角膜后部真菌感染患者病理切片中可见角膜深基质层变性坏死，大量炎症细胞浸润，PAS染色和GMS染色可见典型真菌菌丝侵犯角膜基质深层，而角膜基质浅层及上皮层均未查见真菌菌丝。结论：活体共聚焦显微镜诊断角膜后部真菌感染具有一定的局限性，联合术后病理组织切片和特殊染色检查有助于提高角膜后部真菌感染的诊断率。
Objective: To compare the diagnostic rate between in vivo confocal microscopy and pathological examination in retrocorneal fungal infection. Methods: It is a retrospective study. A total of 18 patients with retrocorneal fungal infection and received PKP surgery in the Qingdao Eye Hospital from November 2009 to December 2020 were enrolled. KOH smear and in vivo confocal microscopy examination were performed before surgery, and pathological examination including periodic acid-schiff (PAS) stain and Grocott Methenamine Silver (GMS) stain were performed after surgery. Patients were diagnosed retrocorneal fungal infection based on in vivo confocal microscopy and pathological examination. The diagnostic rates of the two methods were compared. Results: None of the 18 patients with posterior corneal fungal infection were found to have fungal hyphae in the corneal smear.Sixteen patients (88.9%) were found fungal hyphae by in vivo confocal microscopy. Corneal stroma necrosis and a large number of inflammatory cells were shown by postoperative pathologic examination, and all patients were found fungal hyphae in posterior corneal stroma with PAS stain and GMS stain. Conclusion: Confocal microscopy has unique advantages such as non-invasive and rapid examination in the diagnosis of fungal keratitis.However, it needs to combine with pathological examination for diagnosing the retrocorneal fungal infection.
在热带和亚热带国家，真菌性角膜炎是角膜盲的一个重要原因。随着现代医学的进展，早期真菌性角膜炎通过药物或者手术治疗后治愈率有了显著改善，但是很多真菌性角膜炎患者由于缺乏及时合理的治疗，病情变得迁延难治，预后较差。随着无数学者的努力，近年来在难治性真菌性角膜炎领域在抗真菌药物、给药方式及其他治疗方式上有了一些新的进展，目前可选的难治性真菌性角膜炎治疗方式各有特点及优劣之处。了解目前可用的抗真菌治疗方式、其适应证及不良反应等，是处理难治性真菌性角膜炎病例的必要条件。
Fungal keratitis is a significant cause of corneal blindness in tropical and subtropical countries. With the development of modern medicine, the cure rate of early fungal keratitis has been significantly improved after medical or surgical treatment. However, due to the lack of timely and reasonable treatment for many patients with fungal keratitis, the disease has become difficult to treat and the prognosis is poor. With the efforts of numerous scholars, some new advances have been made in the treatment of recalcitrant fungal keratitis in recent years, such as antifungal drugs and administration methods. At present, the treatment methods of recalcitrant fungal keratitis have their own characteristics, advantages and disadvantages. It is necessary to understand the available antifungal therapies, their indications and side effects for the treatment of recalcitrant fungal keratitis.
真菌性角膜炎是我国导致角膜盲的重要原因之一。由于部分患者在感染早期缺乏合理治疗，导致病情迁延难治，最终行角膜移植是主要的治疗手段。然而真菌感染十分顽固，术后仍有一定概率复发。因此，了解真菌性角膜炎的最新研究进展以及不同类型抗真菌药物和角膜移植手术的优劣，根据适应证选择合理的治疗方案，才能最大程度控制感染，降低真菌复发率，挽救患者视力。与此同时，对角膜移植后真菌复发的相关文献进行研究，总结其复发规律、影响因素和临床特征以及治疗手段和预后。为制订合理的、符合国情的治疗策略提供参考依据。
Fungal keratitis is one of the important causes of corneal blindness in China. Due to the lack of reasonable treatment for some patients in the early stage of infection, the disease is protracted and refractory, and eventually, corneal transplantation is the main treatment. However, Fungal keratitis infection is very stubborn, and there is still a certain probability of recurrence after surgery. Therefore, understanding the latest research advances in fungal keratitis as well as the advantages and disadvantages of different types of antifungal drugs and corneal transplantation, and choosing a reasonable treatment plan according to the indications can maximize the control of the infection, reduce the recurrence rate of the fungus and save the vision of patients. In addition, the relevant literature on fungal recurrence after corneal transplantation was studied to summarize its recurrence pattern, influencing factors and clinical features, as well as treatment means and prognosis. The purpose of this study is to provide a reference basis for formulating a reasonable treatment strategy in line with China’s national conditions.
