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NR 10-12/2007
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Diagnostyka i
postępowanie w grzybiczych zakażeniach rogówki
Fungal infections of the
cornea – diagnostics and management
Beata Rymgayłło-Jankowska, Ewa Rakowska,
Dariusz Haszcz, Agnieszka Kudasiewicz-Kardaszewska, Ewa
Suchodoła-Ratajewicz, Agnieszka Bielińska, Zbigniew Zagórski
Z Katedry i I Kliniki Okulistyki Akademii Medycznej w Lublinie
Kierownik: prof. dr hab. n. med. Zbigniew Zagórski |
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| Summary: |
Fungal keratitis, an
important cause of corneal infectious disease, is one of
the most challenging types of microbial keratitis to
diagnose, isolate the etiologic fungal organism and
treat successfully. Aspergillus spp. are most commonly
responsible for fungal keratitis worldwide. Most cases
occur in hot, humid climates. Fungi invade the ocular
surface only when it is compromised and gain access into
the corneal stroma through a defect in the epithelial
barrier. Pathogens multiply then, and cause inflammatory
reaction together with tissue necrosis. Symptoms of
fungal keratitis typically are not as acute as those of
other forms of microbial keratitis. On examination, both
signs seen in other forms of microbial keratitis and
specific features of fungal keratitis are observed. In
all cases with suspected fungal keratitis, corneal
smears and cultures should be performed as soon as
possible. Antifungal therapy should be restricted to
those cases with fungus-positive laboratory results. The
use of topical corticosteroids in the treatment of
fungal keratitis is contraindicated. In about one-third
of patients pharmacological therapy is not successful.
In those cases, surgical intervention is essential. The
main goal of surgical intervention is to control
infection and maintain the integrity of the globe. The
most commonly performed surgery in fungal keratitis is
therapeutic penetrating keratoplasty. The use of topical
corticosteroids is contraindicated in early
postoperative period. |
| Słowa kluczowe: |
grzybicze infekcje
rogówki, badania laboratoryjne, leki przeciwgrzybicze,
biopsja rogówki, leczniczy przeszczep drążący rogówki. |
| Key words: |
fungal keratitis, corneal
smears and cultures, antifungal therapy, corneal biopsy,
therapeutic penetrating keratoplasty. |
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