目的：评价真菌培养和共聚焦显微镜检查在非首诊真菌性角膜炎患者诊断中的作用。

方法：采用回顾性研究。对2016-09/2017-02于我院住院治疗的非首诊真菌性角膜炎患者的共聚焦显微镜检查和真菌培养检查进行汇总和分析，利用配对四格表资料的χ²检验统计方法比较两种检查的阳性率。

结果：非首诊真菌性角膜炎患者31例31眼中，真菌培养阳性18眼，阳性率58%，角膜共聚焦显微镜检查阳性6眼，阳性率19%，真菌培养检查的阳性率明显高于共聚焦显微镜检查的阳性率，差异有统计学意义(χ²=7.56，P<0.01)。真菌培养阴性的13例13眼患者中，2眼共聚焦显微镜检查阳性； 共聚焦显微镜检查阴性的25例25眼患者中，14眼真菌培养阳性。

结论：对非首诊真菌性角膜炎患者，真菌培养阳性率较角膜共聚焦显微镜检查阳性率更高。真菌培养是诊断非首诊真菌性角膜炎并明确真菌种属的重要辅助检查方法。在临床诊治过程中，共聚焦显微镜检查因其有着快速、无创、可重复操作的特点，也应作为怀疑真菌性角膜炎患者的首选辅助检查。两种检查方法联合应用可提高诊断阳性率。对于部分辅助检查阴性的患者，不可轻易否定其真菌感染的可能性。

METHODS: The clinical data of 31 cases(31 eyes)with non-primary fungaI keratitis from September 2016 to February 2017 in our HospitaI were retrospectiveIy reviewed. The positive rate of the two methods was compared by chi-square test.

RESULTS: The positive rate by fungal culture was 58%(18/31)and IVCM was 19%(6/31); the positive rate comparison difference was statistically significant between fungal culture and IVCM(χ²=7.56,P<0.01). In the 13 eyes with positive culture results, 2 eyes were positive by IVCM; in the 25 positive IVCM eyes, 14 eyes were positive in culture.

CONCLUSION: The positive rate of fungal culture in non-primary fungal keratitis is higher than that of IVCM. Fungal culture is an essential auxiliary examination in the diagnosis of non-primary fungal keratitis. With the characteristics of fast, noninvasive and repeatable, IVCM also plays an important role in the diagnosis of non-primary fungal keratitis. The combination of the two methods can improve the positive rate of diagnosis.