기존 치료에 반응하지 않는 진균 각막염에서 전방내 보리코나졸 주입술의 임상 효과
Clinical Effects of Intracameral Voriconazole Injection in Patients with Fungal Keratitis Refractory to Conventional Treatment
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목적: 기존 치료에 반응하지 않는 진균 각막염에서 전방내 보리코나졸 주입술의 임상 효과에 대해 알아보고자 한다. 대상과 방법: 진균 각막염으로 진단받고 치료를 시행 받은 환자 38명(38안)을 대상으로 항진균제의 점안 투여에 더하여 전방내 보리코나졸 주입술(50 μg/0.1 ml)을 시행 받은 군(13안, A군) 또는 암포테리신 주입술(100 μg/0.1 ml)을 시행 받은 군(11안, B군)과 항진균제의점안 투여만을 시행 받은 군(14안, C군)의 3군으로 분류하여 치료 성공 여부 및 치료 성공까지 걸린 기간 등을 조사하였다. 결과: 치료 성공률은 A군의 12안(92.3%), B군의 10안(90.9%), C군의 12안(85.7%)이었다. 치료 성공까지의 기간은 C군의 49.5 ± 16.7일과 비교하여 A군에서 36.1 ± 10.4일(p=0.04), B군에서 34.2 ± 7.8일(p=0.03)로 주입술 후 좀더 빠른 호전을 보였으며, 상피결손의회복 및 전방축농의 소실까지 걸린 기간도 비슷한 양상을 보였다. 결론: 점안 및 치료에 반응하지 않는 진균 각막염의 경우 전방내 보리코나졸 주입술은 전방내 암포테리신 주입술의 효과와 유사하게치료에 도움이 될 수 있을 것으로 생각한다.
Abstract
Purpose: To evaluate clinical effects of intracameral voriconazole injection in fungal keratitis refractory to conventional therapy. Methods: Thirty-eight eyes of 38 patients with fungal keratitis were included in this study. The patients were divided into 3groups: 13 patients with intracameral voriconazole injection (50 μg/0.1 ml; group A), 11 patients with intracameral amphotericin B injection (10 μg/0.1 ml; group B), and 14 patients with conventional therapy only (group C). Clinical factors including treatment success rate and time to successful treatment were evaluated. Results: Treatment success was accomplished in 12 eyes in group A (92.3%), 10 eyes in group B (90.9%), and 12 eyes in group C (85.7%). Time to treatment success in group A, B, and C was 36.1 ± 10.4 days (p = 0.04), 34.2 ± 7.8 days (p = 0.03),and 49.5 ± 16.7 days, respectively. Patients who had received intracameral voriconazole injection or amphotericin B showed faster fungal keratitis improvement than patients who received conventional treatment. Time to re-epithelialization and time to disappearance of hypopyon showed a similar clinical course. Conclusions: Intracameral voriconazole injection, which has a similar therapeutic effect as intracameral amphotericin B injection in the management of fungal keratitis, can be helpful in the treatment of intractable fungal keratitis.
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