Clinical characteristics of severe fungal keratitis

岳利輝

Abstract objective ：to retrospectively analyze the epidemiological characteristics， diagnosis， treatment and prognosis of 358 cases of fungal keratitis in wuhan union hospital. Methods： a retrospective analysis was performed on the epidemiological characteristics and clinical diagnosis and treatment of fungal keratitis among the keratitis patients who were hospitalized and treated in the affiliated union hospital of tongji medical college of huazhong university of science and technology from January 2005 to March 2012. Results： among the 920 patients with keratitis， there were 358 cases of fungal keratitis， accounting for a high proportion （38.9%）， among which corneal injury （52.79%）， especially plant injury， was the most important risk factor.

Key words：severe fungal keratitis; Clinical features; Retrospective analysis

【中圖分類號】 R197.8

【文獻標識碼】 B? 【文章編號】 1672-3783（2019）04-03-252-02

Chapter 1 Introduction

In agriculture and developing countries， including China， fungal keratitis （ulcer） is an infectious corneal disease with a high rate of blindness and in severe cases loss of the eyeball. Eyeball trauma， especially plant trauma， widespread use of antibiotics and corticosteroids， etc.

Chapter 2 Object

2.1 The object of study

Level 3 first-class hospital in hubei area as the research basis， xiehe hospital affiliated to tongji medical college huazhong university of science and technology of retrospective investigation and study， on the medical record department collected in January 2005 to March 2012 in wuhan xiehe eye hospital treatment， a total of 920 cases diagnosed as keratitis （ulcer） of the patient's medical records （including fungal and viral， bacterial， borderline and so on various types of keratitis patients）.

2.2 Content of data collection

The following information was recorded for all patients with keratitis （ulcer） ： （1） on admission， vision and slit lamp examination， corneal lesion characteristics and anterior chamber signs; （2） direct smear results of corneal ulcer curettage and intraoperative corneal tissue pathological examination results; The treatment method and treatment outcome of our hospital.

Chapter 3 Treatment

3.1 Drug treatment

（1）Antifungal treatment： most patients received local 0.2% fluconazole eye drops after admission， and combined with 0.125% amphotericin B once every 1/2 to 1h （25mg amphotericin B was mixed with 20ml rifampicin eye water， which was divided into 10ml/ bottle） once every 2h， and used 1% miconazole eye cream prepared in our hospital at night. （2） vitamin drugs to promote corneal repair： oral multivitamin B， intravenous vitamin C2g/d; （3） according to the patient's condition， combined with other drugs： such as adding anti-bacterial， antiviral drugs;

3.2 Surgical treatment

For some patients， after the above drug treatment， the disease has been initially controlled and the focus has been limited， but the disease stagnated with no further signs of improvement， or sometimes repeated worsening.

Chapter 4 Result

Clinical cure： corneal epithelium fluorescein staining negative， corneal matrix infiltration absorption， fibrosis or scar， anterior chamber pyomea disappeared;（1）Traumatic healing： enucleation or enucleation of eye contents during hospitalization; （2） better： corneal ulcer lesion range reduced， infiltration reduced， pseudopod， satellite focus or anterior chamber pyoesis reduced or reduced; （3） unhealed： corneal ulcer lesions could not be controlled， the area expanded， infiltration deepened or corneal perforation， anterior chamber pyesis increased， high intraocular pressure complications occurred.

Chapter 5 Conclusion

In summary， the fungal keratitis （ulcer） in our hospital showed an increasing trend year by year， most of the patients were farmers， plant trauma was the main cause， and the application of antibiotics was extremely excessive. Corneal spatula is an important method for early and rapid diagnosis. Amniotic membrane transplantation and lamellar keratoplasty are the main and effective surgical methods. Surgical intervention at an early stage when antifungal therapy is ineffective or ineffective can prevent irreversible enucleation or enucleation of eye contents due to delayed treatment of some treatable fungal keratitis （ulcer）.

參考文獻

[1]Nayak N， Satpathy G，Prasad S，et al. Molecular characterization ofdrug-resistant and drug-sensitive Aspergillus isolates causing infectiouskeratitis[J].Indian J Ophthalmol，2011，59（5）：373-377.

[2]Moen MD， Lyseng-Williamson KA， Scott LJ，et al. Liposomal amphotericin B：a review of its use as empirical therapy in febrile neutropenia and in thetreatment of invasive fungal infections[J].Drugs，2009;69（3）：361-392.

[3]Avisar I， Weinberger D， Kremer I. Fusarium keratitis and endophthalmitistreated by intravenous ambisome[J].Harefuah，2009，148（1）：28-29， 88.

[4]Kaji Y， Yamamoto E， Hiraoka T， et al.Toxicities and pharmacokinetics ofsubconjunctival injection of liposomal amphotericin B[J].Graefe's Archive forClinical and Experimental Ophthalmology，2009，247（4）：549-553.