보리코나졸 점안이 배양 양성 진균각막염 치료에 미치는 임상 효과의 분석
Clinical Efficacy of Topical Voriconazole as Treatment in Culture-Positive Fungal Keratitis
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목적: 보리코나졸 점안이 배양 양성 진균각막염의 치료에 미치는 영향에 대해서 알아보고자 하였다. 대상과 방법: 2004년 10월부터 2010년 12월까지 서울대학교병원에서 배양검사양성 진균각막염으로 진단된 22명 22안의 의무기록을후향적으로 분석하였다. 점안치료 방법에 따라 세 군으로 나누었고, 보리코나졸 단독 사용군(V, n=6), 보리코나졸과 엠포테리신B 병합사용군(V+, n=10), 엠포테리신B 단독 사용군(A, n=6)으로 나누어 분석하였다. 결과: 세 군의 치료성공률은 차이가 없었다. 관해된 경우 V군에서 V+군보다 각막상피결손 회복기간이 짧았다. Fusarium spp.감염과전방축농은 점안치료 실패의 위험인자였다. 8안에서 상피결손 회복 후 평균 66일 동안 보리코나졸 유지요법을 시행했고 각막상피의미란이나 결손 소견은 보이지 않았다. 결론: 보리코나졸 점안치료는 표준 치료에 비해 진균각막염 관해에서 각막 상피 결손의 회복이 빠르고 효과가 필적한 것으로 생각하나Fusarium spp.감염에 대해서는 다른 표준치료와 마찬가지로 효과가 떨어지며 수술적 치료가 필요한 가능성이 높다.
Abstract
Purpose: To evaluate the efficacy of topical voriconazole in treatment of culture-positive fungal keratitis. Methods: Twenty-two cases of culture-positive fungal keratitis treated with topical anti-fungal drugs from October 2004 to December 2010 were evaluated and medical records were reviewed. Patients were divided into 3 groups according to the method of topical antifungal treatment; the first group (V, n = 6) received voriconazole monotherapy, the second group (V+,n = 10) received topical voriconazole and amphotericin B combined therapy, and the third group (A, n = 6) received amphotericin B monotherapy. Results: The treatment success rate between the 3 groups was not significantly different. The epithelial defect healing time of group V was shorter than group V+. Treatment failure risk factors included Fusarium spp. infection and the presence of hypopyon. Eight eyes received topical voriconazole maintenance therapy for 66 days and there were no corneal erosions or epithelial defects. Conclusions: In fungal keratitis, topical voriconazole is as effective as other standard treatments and provides a faster healing time in the corneal epithelium than other standard treatments. However, voriconazole should be used with caution and therapeutic surgery should be considered in Fusarium spp. infections.
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