Successful treatment of chronic stromal acanthamoeba keratitis with oral voriconazole monotherapy.
Successful treatment of chronic stromal acanthamoeba keratitis with oral voriconazole monotherapy.
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DOI：
10.1097/ico.0b013e3181cbfa2c
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发表时间：
2010-09
期刊：
影响因子：
2.8
通讯作者：
Shoff ME
中科院分区：
文献类型：
--
作者：
Tu EY;Joslin CE;Shoff ME
描述口服伏立康唑单药治疗慢性基质阿米巴角膜炎。回顾了2003年6月至2009年7月在伊利诺伊大学眼耳医院接受传统治疗后接受全身伏立康唑治疗的所有慢性基质阿米巴角膜炎病例的临床表现、临床病程和结局。2例患者的3只眼经培养证实为慢性基质阿米巴角膜炎，对传统抗棘阿米巴治疗无反应，需要外用皮质类固醇来维持角膜透明度。口服伏立康唑200 mg，每日两次，可迅速但短暂地减轻炎症，消除皮质类固醇依赖性，但两例患者在停药后约6周复发。随后重复和/或延长单独口服伏立康唑导致完全消退，范围为7-11个月，停用所有药物，最终BCVA范围为20/20-20/25。顽固性慢性阿米巴角膜基质炎成功地治疗了延长全身伏立康唑管理与良好的保护视力。在我们的两个病例中，慢性基质角膜炎的临床消退表明伏立康唑在阿米巴角膜炎的治疗中可能具有更大的作用。
To describe the treatment of chronic stromal Acanthamoeba keratitis with oral voriconazole monotherapy. All cases of chronic stromal Acanthamoeba keratitis recalcitrant to traditional therapy subsequently treated with systemic voriconazole seen at the University of Illinois Eye and Ear Infirmary between June, 2003 and July, 2009 were reviewed for clinical presentation, clinical course and outcome. Three eyes of two patients were identified with culture-confirmed chronic stromal Acanthamoeba keratitis unresponsive to traditional anti-acanthamoebal therapies, requiring topical corticosteroids to maintain corneal clarity. Oral voriconazole 200mg twice daily achieved a rapid but transient reduction of inflammation and elimination of corticosteroid dependency, but, in both patients, recrudesced approximately 6 weeks after its discontinuation. Subsequent repeated and/or extended use of oral voriconazole alone resulted in complete resolution ranging from 7-11 months off all medications with final BCVA ranging from 20/20-20/25. Recalcitrant, chronic Acanthamoeba stromal keratitis was successfully treated with extended systemic voriconazole administration with good preservation of vision. The clinical resolution of chronic stromal keratitis in our two cases suggests that voriconazole may have a larger role in the treatment of Acanthamoeba keratitis.