Comparative study of fungal culture and in vivo confocal microscopy in the diagnosis of non-primary fungal keratitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare fungal culture and in vivo confocal microscopy ( IVCM ) in the diagnosis of non- primary fungal keratitis.?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 (x2=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.

Clinical observation of 15 cases of corneal foreign body injuries caused by chestnut thorns / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AIM:To investigate the effective treatment methods of corneal injury caused by chestnut thorns and the factors affecting the disease progression.?METHODS: From Jul.2014 to Oct.2015, the clinical data of 15 patients(15 eyes) with corneal injury caused by chestnut thorns in Ophthalmology Inpatient Department of Wuhan Tongji Hospital was retrospective analyzed. The patients without fungal keratitis were treated with the surgery of removing chestnut thorn from cornea and antifungal drugs. For the patients complicated with fungal keratitis, besides surgery of removing chestnut thorn and antifungal drugs, anterior chamber irrigation and corneal stroma injection with fluconazole solution were given to treat the disease.If necessary, amniotic membrane transplantation or keratoplasty was also given to the patients complicated with fungal keratitis. After that, the effectiveness of those methods and the factors affecting progression were analyzed.?RESULTS:For 11 patients without fungal keratitis, the average time between corneal injury and receiving treatment at Tongji Hospital was 1-7 (2.42±2.15) d and for 4 patients complicated with fungal keratitis, the average time was 3-30 (18.25±4.35)d.Among 15 cases, statistics suggested that the average number of chestnut thorn in patients complicated with fungal keratitis was 4.5, and all the chestnut thorn penetrated the cornea into the anterior chamber.The average number of chestnut thorn in patients without fungal keratitis was 3.5, and the proportion of chestnut thorn penetrated the cornea into the anterior chamber was 28.5%.After treatment, all patients had no new fungal keratitis or other complications.Those results indicated that the different treatments for the patients with or without fungal keratitis were all effective.?CONCLUSION:The factors affecting the progression of cornea foreign body injury caused by chestnut thorn are the number of chestnut thorn, whether chestnut thorn penetrate the cornea into the anterior chamber, time since injury, active anti -fungal therapy. If patients complicated with fungal keratitis could be treated with antifungal agents and anterior chamber irrigation or corneal stroma injection using fluconazole solution without delay, the progress of fungal keratitis could be effectively controlled, and favorable conditions for further therapy such as amniotic membrane transplantation or keratoplasty could be provided.