PRINCIPLES IN MANAGEMENT OF OCULOMYCOSIS - XXXI JACKSON,E MEMORIAL LECTURE
PRINCIPLES IN MANAGEMENT OF OCULOMYCOSIS - XXXI JACKSON,E MEMORIAL LECTURE
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DOI：
10.1016/0002-9394(75)90730-8
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发表时间：
1975-01-01
影响因子：
4.2
通讯作者：
JONES, BR
中科院分区：
文献类型：
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作者：
JONES, BR
有效的抗真菌治疗必须是长期的，非损伤性的，穿透眼睛的，对每个病人的真菌高度活跃。抗真菌药敏感性测试的61个收集的眼部真菌病原体和观察25例治疗的非多烯类抗真菌药物之一的结果表明，感染迅速控制和根除视力恢复，确定了在合理的具体的抗真菌治疗开始时存在的混乱程度。匹马菌素具有最宽的谱，中等水平的活性，并且渗透性相当差，但被推荐作为抗真菌预防剂和眼部真菌疾病的一线治疗，同时等待真菌的鉴定和敏感性测试。氟胞嘧啶联合阿替霉素B，或可能与克霉唑或咪康唑，建议用于念珠菌感染。克霉唑是曲霉菌的首选药物，尽管咪康唑和益康唑对某些菌株更有效。咪康唑和益康唑被推荐用于各种丝状真菌，尽管克霉唑或噻苯达唑在某些情况下更上级。这些药物中的每一种都可能对感染镰刀菌的患者有用，这些患者对伯马菌素没有反应。在这些情况下，药物使用应根据抗真菌药敏试验的结果进行指导。除了药物抗真菌治疗外，有些眼睛可能需要切除角膜移植术，同时取出透镜并排空后房和前玻璃体腔。
Effective antifungal therapy must be long-term, nondamaging, penetrating to the eye, and highly active against each patient's fungus. Results of antifungal sensitivity testing of 61 collected ocular fungal pathogens and observations in 25 cases treated with one of the nonpolyene antifungal drugs indicated that infection was rapidly controlled and eradicated with restoration of visual acuity, determined by the degree of disorganization present at the time of commencement of rational specific antifungal therapy. Pimaricin has the widest spectrum, a medium level of activity, and rather poor penetration but is recommended as an antifungal prophylactic and as first-line-therapy for ocular fungal disease while awaiting identification and sensitivity testing of the fungus. Flucytosine combined with amphotericin B, or possibly with clotrimazole or miconazole, is recommended for Candida infections. Clotrimazole is the drug of choice for Aspergillus species although miconazole and econazole are more effective with some isolates. Miconazole and econazole are recommended for miscellaneous filamentous fungi although clotrimazole or thiabendazole are superior in some cases. Each of these drugs may be useful in patients infected with Fusarium who do not respond to primaricin. In these cases, drug use should be guided by the results of antifungal sensitivity testing. In addition to medical antifungal therapy some eyes may require excisional keratoplasty with the lens removal and evacuation of the posterior chamber and anterior vitreous cavity.