Penetrating keratoplasty for treatment of high-risk fungal keratitis A 51-case report

Guiqiu ZHAO; Nan JIANG; Liting HU; Chengye CHE

ABSTRACT

BACKGROUND:

Simple drug therapy can not acquire satisfactory effects in treatment of fungal keretitis. At present, penetrating keratoplasy (PKP) has been considered a primary means to cure the fungal keratitis to save eyeball and vision.

OBJECTIVE:

To evaluate the clinical efficacy of PKP in the treatment of high-risk fungal keratitis.DESIGN, TIME AND

SETTING:

A retrospective case analysis was performed at the Department of Ophthalmology, Affiliated Hospital of Qingdao University Medical University between January 2000 and January 2007.

PARTICIPANTS:

A total of 51 patients (51 eyes) with high-risk fungal keratitis who underwent PKP in the Affiliated Hospital of Qingdao University Medical College were recruited into this study. Of these patients, 12 suffered from perfored, 35 from hypopyon, 8 from complicated cataract prior to surgery, and 5 from complicated glaucoma.

METHODS:

All patients received antifungal and antibacterial treatments prior to surgery and underwent PKP within 4 days following admission. After surgery, antifungal and antibacterial treatments were performed locally and systemically. All patients were followed-up for 6--24 months.MAIN OUTCOME

MEASURES:

Postoperative visual acuity, recurred fungal infection, rejection of implants, secondary glaucoma, and ulceration of implant.

RESULTS:

① Of 51 patients, 18 were followed-up for 6-12 months, 2 for 13-18 months, and 8 for 19-24 months. ② A total of 49 (96.1%) out of 51 patients preserved the eyeballs and the visual acuity improved to different degrees in 48 (94.1%) patients. ③ After surgery, fungal infection recurred in 6 eyes (11.6%), 4 of which were controlled by antifungal medication and 2 was enucleated because of uncontrolled endophthalmitis. Graft rejection was found in 18 (35.3%) eyes, 13 of which recovered transparent by medication and 5 received secondary PKP. Graft ulceration was present in 4 (7.84%) eyes, 3 of which were cured and the remaining one was re-grafted because of severe endothelial cell loss. Secondary glaucoma appeared in 7(13.7%) eyes, and the intraocular pressure was controlled medically and surgically. Complicated cataract occurred in 6 (11.8%) eyes, 3 of which underwent cataract extraction. Most complications were successfully controlled. In the final follow-up period, 45 (88.2%) grafts were transparent.

CONCLUSION:

PKP is an effective approach to preservation of eyeballs and restoration of visual function in patients with high-risk fungal keratitis, which can not be treated by conservative therapy.