pimaricin與碘化鉀合併使用對角膜真菌症之療效2病例報告

Effective Treatment of Keratomycosis with the Use of Pimaricin Combined with Potassium Iodide-A Report of Two Cases-

陳振武(C. W. Chen) ； 許明木(M. M. Hsu) ； 吳文權(M. K. Wu)

《中華民國眼科醫學會會刊》 19卷 (1980/05) Pp. 141-148

https://doi.org/10.30048/ACTASOS.198005.0021

摘要

本文報告二例陳舊性角膜真菌症。第1例係38歲男工人，右眼角膜異物除去後發病，雖經多位眼科醫師治療不見效而惡化，約一個月後經轉介來院接受pimaricin合併碘化鉀液點眼治療之後有顯著效果而治癒。培養成績有酵母樣真菌及白色葡萄狀球菌。但不併用對付後者之抗生素。視力治療前僅眼前辨指數，治癒後3個月追踪時恢復至0.5。
第2例係62歲男農夫，右眼誘因不明而發生角膜潰瘍，雖經醫治2個多月但無效而進行之陳舊病例，潰瘍及浸潤涉及幾乎全面之全層角膜，角膜已有明顯之組織缺損。抹片檢查多次皆有多量之真菌絲，但二次不同日期之真菌培養失敗。另培養細菌有白色葡萄球菌及mima polymorpha。主要治療使用pimaricin及碘化鉀液點眼另併用Amikin，或Lillacilin，或Keflodin點眼。本例雖有明確療效，但因陳舊性及深達性病變，組織修復較緩慢，9星期後治癒，幸能避免角膜穿孔。視力僅由眼前手動恢復至辨指數，幸尚適應做角膜移植手術。

並列摘要

Two cases of keratomycosis were reported. Case 1 was a 32-year-old male, factory worker, suffering from corneal ulceration in the right eye for one month after the removal of a corneal foreigm booy. On microscopic examination of the corneal scrapings, fungus hyphae wera found. Yeast-like fungi were isolated in association with staphylococcous albus. Treatment with 5% pimaricin and 1% potassium iodide, q. 1. h. resulted in rapid effective response. The lesion started to improve a few days after the inition of treatment and healed up in one month when the medication was withdrawn completely. A follow up two and a half month after the cure, the eye was white and quiet leaving a nebule on the cornea. The vision was counting fingers before treatment and recovered to 0.5.
Case 2 was a 62-year-old male farmer, suffering from corneal ulceration in the right eye for 2 months. There was no history of preceding injury of the eye. The corneal lesion had progressed in spite of treatment by practicing ophthalmologists. The eye was severly painful. The whole cornea was involved by a wide extent of infiltration with ulceration that involved the whole layres of cornea. Hypopyon of 2 mm hight was present. The anterior chamber and posterior segment of the eye were in obscurity. On microscopic examination of corneal scrapings stained with lactophenol cotton blue revealed abundant micelia of unidentified fungi. Two cultures, repeated in different days, however, failed. Bacterial culture reported the growth of staphylococcus albus and mima polymorpha that showed marked sensitivity to wide variety of antibiotics routinely used in ophthalmic practice.
Treatment with 5% pimaricin and 1% potassium iodide q. 1. h. against the fungus and 1% amikin q. i. d. resulted in the disappearance of hypopyon in 3 weeks. Both symptom of tearing and eye pain, and signs such as corneal infiltration and ulceration improved very slowly. The antibiotis were changed to 10% Lillacillin and then to 5% keflodin in combination with the consecutive pimaricin and potassium iodide. The lesion cured after 8 weeks of treatment without perforation of the cornea leaving a dense corneal opacity. The vision finally recovered to finger counting from hand movement before treatment.
Pimaricin was a effective drug against keratomycosis as a first choice of treatment when microscopic evidence of mycotic infection is obtained in scrapings. Toxic effect was not encountered. The combined use of potassium iodide with pimaricin would possibly give better result. The mechanism of action was discussed.

並列關鍵字

Cornea ； mycosis ； pimaricin ； potassium iodide ； yeast