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Introduction: Corneal ulcer is one of the important causesfor ocular morbidity in India. Early presentation with promptdiagnosis and treatment result in good visual rehabilitation.Aim: The aim of this study was to assess the etiology ofcorneal ulcer among patients attending the tertiary careteaching hospital of Jharkhand.Material and Methods: This was a prospective observationalhospital-based study conducted at the Department ofOphthalmology, at a tertiary care hospital, in Jharkhand.Data related to socioeconomic status, predisposing factor,and course of disease was collected. Results were analyzedon the basis of history, slit lamp examination, and appropriatelaboratory investigation.Result: During the study period of one year, 1013 patientswith the clinical diagnosis of corneal ulceration wereevaluated, mean age of the patient was 53 years and majorityof patients of infectious keratitis were in between 46 and 60(45%) age group. Incidence in male was higher than (59%)that of female. The left eye was more commonly involved(53%) as compared to the right eye (47%). Farmers (47%)followed by Industrial worker (27%) were most commonoccupation involved. Incidence of fungal keratitis (42%) washigher than bacterial (31%) and viral (11%).Conclusion: Proper diagnosis and management of cornealulcer is very much necessary among exposed population.Incidence of fungal corneal ulcer is very high amongagriculture and industrial workers and lack of awareness andpoor treatment leads to corneal blindness. Use of protectiveeye wear, masks and face shields may play a key role inprevention of the disease
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@#AIM: To investigate the efficacy of lamellar keratoplasty(LKP)combined with accelerated(45mW/cm2)corneal cross-linking(A-CXL)on refractory fungal corneal ulcer.<p>METHODS: Eighteen eyes of 18 patients with refractory fungal corneal ulcer were enrolled in the Department of Ophthalmology, First Affiliated Hospital of Jiangxi Medical College from January 2017 to November 2018. The postoperative visual acuity, corneal graft transparency, the incidence and prognosis of complications such as fungal recurrence, graft rejection, secondary glaucoma and complicated cataract were all recorded.<p>RESULTS: All the patients succeeded in avoiding enucleation or evisceration. Postoperatively, 16 eyes(89%)gained one or more lines in uncorrected distance visual acuity 2 eyes(11%)had unchanged in uncorrected distance visual acuity. Three eyes(17%)had a graft rejection. Secondary glaucoma were detected in 2 eyes(11%), and concomitant cataract were found in 3 eyes(17%). Thirteen eyes(72%)had transparent grafts, 4 eyes(22%)had translucent transects, and the remaining one eye(6%)had a turbid graft.<p>CONCLUSION: LK combined with A-CXL may be feasible for refractory fungal corneal ulcer treatment by improving the cure rate.
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Keratomycosis is a major cause of blindness, especially in the developing world. A major proportion of these are caused by fungi, of which pigmented fungi is a good number. Pigmented fungal corneal ulcers may present with surface pigmentation, helping in diagnosis but the presumptive treatment is usually started after evaluation of smears made from scrapping samples. Aggressive treatment with topical anti-fungals help accelerated healing in most of them but few still worsen and need therapeutic keratoplasty. In this study, we evaluated the cases of pigmented Keratomycosis presenting in a tertiary care center for various factors like demographic details, risk factors, clinical characterstics, response to treatment and prognosis
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AIM:To analyze the clinical efficacy of conjunctival flap covering combined with subconjunctival injection of fluconazole on patients with severe fungal corneal ulcer.METHODS:Totally 50 cases with severe fungal corneal ulcer were collected in our hospital from January 2012 to December 2015.The cases were randomly divided into observation group and control group,25 cases in each group.All the cases were monocular sick.The control group took single drug treatment,but the observation group were given with conjunctival flap as an extra.The clinical efficacy,best corrected visual acuity and adverse effects rate were observed.And,the relapse of the two groups was followed for 1a.RESULTS:After 1 mo of treatment,the clinical curative effect of the observation group was significantly higher than the control group (P＜ 0.05),and corrected visual acuity of the observation group was higher than the control group (P＜0.05);the adverse reaction rate of the observation group was lower than the control group (P＜0.05).After 1a follow-up,the observation group only had 1 case of recurrence,control group had 8 cases with recurrence,the recurrence rate of the observation group was significantly lower than the control group (P＜0.05).CONCLUSION:The conjunctival flap combined with subconjunctival injection of fluconazole has good application value in severe fungal corneal ulcer patients,can effectively improve the clinical curative effect and the visual acuity,and can effectively reduce the incidence of adverse reactions and recurrence rate.
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Objective To assess the treatment outcomes of anterior segment optical coherence tomography(OCT) assisted excimer laser phototherapeutic keratectomy (PTK) for fungal corneal ulcer.Methods Twenty-four patients (24 eyes) suffered from fungal corneal keratitis were collected by a retrospecive chart review with at least 6 months of follow-up data available.All corneal ulcer depth did not exceed 1/3 corneal thickness and were resistant to local and systemic medication therapy for at least 1 week.Patients were divided into 2 groups.14 patients with 14 eyes were taken PTK and 10 patients with 10 eyes were treated with lamellar keratectomy.Follow-up time was at least 6 months.Visual acuities,corneal thickness,confocal microscope,healing of the epithelial defect and inflammation and complications were recorded.Results The postoperative visual acuity in two groups were significantly improved,visual acuity of PTK treatment group improved significantly better than the control group (P ＜ 0.05).Healing time of PTK treatment group (19.43 ± 5.68) days was shorter than that of the control group (34.40 ± 5.38) days,the difference was statistically significant (P ＜0.05).There was no significant difference in the residual central corneal thickness between the PTK treatment group and the control group (P ＞ 0.05).Residual mycelium after operation in the treatment group was significantly decreased than that of control group.Healing time of epithelial in PTK treatment group (4.0 ± 1.1) days was shorter than that of the control group (6.20 ± 1.39) days,the difference was statistically significant (P ＜ 0.05).There was no corneal dilation in two groups.No recurrence in PTK treatment group was occurred.3 cases in control group had recurrence after 6 months,drug control was effective in 1 case,and other 2 cases undertook corneal transplantation.Conclusion Anterior segment OCT assisted PTK for corneal ulcer can effectively clear the lesion,accelerate epithelial healing,provide a new choice for the treatment of early superficial fungal corneal ulcer.
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AIM:To observe the transplantation of acellular porcine corneal stroma on the treatment of superficial keratitis by drug-resistant fungal.METHODS:We performed a retrospective analysis of 16 cases of fungal keratitis received the transplantation of acellular porcine corneal matrix from June 2015 to March 2016 with a follow-up of 6mo.We analyzed on items as postoperative visual acuity, corneal graft status, postoperative recurrence and postoperative complications.RESULTS:We observed a healing time of corneal epithelium in 7 to 10d postoperatively generally and the absence of corneal edema in 1mo, while the cornea gradually returned transparent in the 16 cases.Two cases required medication for an epithelial recovery and 3 cases received intervention for decreasing intraocular pressure to a certain level.During the follow-up we observed no cases of cornea degeneration, recurrence of infection or rejection.The vision acuity showed 1.27±0.22, 1.11±0.13, 0.79±0.22 in 1, 3 and 6mo after operation respectively.There was no statistical difference between vision in 1mo and the vision before surgery (P=0.06);while we found a statistical difference when comparing the vision of 3 and 6mo with vision before surgery (P=0.01,0.001).The vision in 6mo increased with a statistic difference to the vision at 1 and 3mo (P<0.001) while no statistic difference was observed between 1 and 3mo(P=0.11).CONCLUSION:Transplantation of acellular porcine corneal matrix is a safe and efficient treatment for fungal keratitis.
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AIM:To explore the effect of comprehensive therapy in the treatment of fungal corneal ulcer and clinical outcome. METHODS:A total of 159 cases 159 eyes fungal corneal ulcer patients took comprehensive therapy of 10 measures, followed up more than 3mo to observe the treatment effect and the final visual acuity in our hospital for treatment. RESULTS: The average hospitalization time of fungal corneal ulcer was(12. 11±5. 13) d. A total of 148 cases of 148 eyes were cured, and the cure rate was 93. 1%;improvement in 8 cases, accounted for 5. 0%; 3 cases were ineffective, accounted for 1. 9%. The final visual acuity of 89 eyes ≥0. 3, accounted for 56. 0%(89/159). The final visual acuity of 136 eyes ≥0. 1, accounting for 85. 5%(136/159), and accounting for 91. 9% in 148 cured patients. CONCLUSION: The comprehensive therapy in the treatment of fungal corneal ulcer has higher cure rate and visual acuity.
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AIM:To examine the efficacy and safety of cryotherapy in the management of Fusarium corneal ulcer. METHODS: Retrospective contract analysis of the clinical data of 41 patients ( 41 eyes ) who infected with Fusarium corneal ulcer. All of them underwent focal lesion keratectomy combined with amniotic membrane transplantation between January 2010 and May 2013. The cryotherapy treatment group of 22 cases (22 eyes), non-cryotherapy group of 19 cases ( 19 eyes ) . All the cases were followed up for 3 ~12mo. We analyzed the healing of corneal ulcer, corneal neovascularization, postoperative visual acuity, complications and ulcer recurrences. RESULTS: There were no significant difference for the two groups at the cure rate and the recovery rate, the corneal neovascularization and postoperative visual acuity (P>0. 05). The total effective rate and corneal healing time in cryotherapy group was significantly higher than that in non - cryotherapy group ( P CONCLUSION: Cryotherapy is an effective and safe method for the treatment of Fusarium corneal ulcer.
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The study was carried out in 372 patients with fungal corneal ulcer at the Central Hospital of Ophthalmology in 2004. Results showed that: this disease is more common in women than men, at working age from 20 to 60. 100% of inpatient had fungal using fresh sample microscopy test. The majority of patients came to hospital after having symptoms from 1 to 2 weeks. The patients were treated by two method: internal treatments (55.3%) and surgery (44.7%). Internal treatments included antifungal, antibiotics, anti-inflammatory and anti-necrosis antibiotics, cornea nutrition agents, lugol solution 2%, potassium iodide electrophoresis 2%, midriasis collyre…; Surgical procedures included trabeculectomy 5%, corneal sharpening 50%, corneal graft 18%, tarsorrhaphy 01%, intraocular remove 12%. Patient's vision did not increase significantly, fingers count was under 5m. In general, treatment did not obtaine significant improvements because of late admission and severe disease, treatment duration was about 99 days. This disease may persistent, recurrent. Poor vision causes many severe complications, especially perforation occurred in 21/147 inpatients
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Corneal Ulcer , TherapeuticsABSTRACT
PURPOSE: Various studies on amniotic membrane transplantation for ocular surface reconstruction have been reported. To investigate the effect of human amniotic membrane transplantation on corneal fungal ulcer, we reviewed the records of four fungal ulcer patients. METHODS: Human amniotic membranes were transplanted to the diseased corneas under topical anesthesia within 12 hours. RESULTS: After the mean observation period of 8.5 months, cornea was stabilized in all eyes. No aggravation or rejection were observed. Secondary penetrating keratoplasty was performed in 2 cases. CONCLUSION: Amniotic membrane transplantation may be effective to promote corneal wound healing in refractory fungal ulcer and considered as a useful treatment prior to corneal transplantation.