RESUMO
AIM: To evaluate the correlation between Demodex infestation and keratitis, and to assess demodicosis using a simple approach. METHODS: A modified slit lamp illumination (at 40× magnification) was used to observe Demodex tails in 40 patients with refractory keratitis and 80 healthy controls. Bacterial smear and culture of the conjunctival sac and corneal lesion were performed to identify the pathogen. Tea tree oil ointment (TTOO) was added as a Demodex killing agent for lid scrubs to the treatment when Demodex infestation was confirmed. RESULTS: Demodex tails were found in all patients compared to 42/80 of the controls (P<0.01). Seventeen patients presented blepharitis, while 23 were free of scales and inflammation at the lid margin. The demodicosis was mild, moderate, and severe in 8, 19, and 13 patients, respectively, compared to mild in 42 controls (P<0.01). The keratitis was mild, moderate, and severe in 13, 19, and 8 patients, respectively. The severity of Demodex infestation was not correlated to the severity of keratitis (P=0.126). The growth of Staphylococcus was revealed in nine patients who did not react to antibiotic eye drops prior to the TTOO treatment. Patients' signs and symptoms got resolved after the lid scrub with TTOO. CONCLUSION: Ocular Demodex needs to be checked and treated in refractory keratitis patients with or without blepharitis. A slit-lamp illumination under high magnification favors the judgment of the severity of Demodex infestation.
RESUMO
OBJECTIVE: To analyze the distribution of pathogenic bacterium of the fungal keratitis patients for providing the data of clinical diagnosis and treatment. METHODS: From July 2005 to December 2010 in Shandong Eye Hospital there were 352 smears of corneal ulcers and corneal tissue exemplar removed in surgery from fungal keratitis patients. The all exemplars were cultured with the Sabouraud dextrose agar culture media in 28°C under the humidor for 7 days. The strains was identified according to the appearance of fungal colonies, mycelium, spore shape, spore arrangement and fungal shape. And there did the retrospective analyses about the positive rate of fungal culture, genus distribution, seasonal distribution and sources of patients, sex ratio, age distribution and occupation. etc. RESULTS: There were 334 stock positive fungal culture in 352 cultured specimens from fungal corneal ulcers, the positive rate was 94.9%. There were 187 positive culture from 203 corneal scraping exemplars, the positive rate was 92.1%; there were 147 positive culture from 149 corneal tissue removed in surgery, the positive rate was 98.7%. The Fusarium strains was most common in all isolated strain, 211 (63.2%). The Aspergillus was secondly 47 (14.1%). The character of seasonal distribution of culture positive strain: the 48 strains (14.4%) were cultivated from January to March; the 48 strains (14.4%) were cultivated from April to June; the 64 strains were cultivated (19.2%) from July to September; the 174 strains (52.0%) were cultured from October to December, the ratio were 1:1:1.3:3.6 quarterly (χ(2) = 3.360, P = 0.339). The incidence of fungal keratitis were higher in the autumn and winter than in spring and summer. The ratio of the male and the female was 2.04:1 in 334 culture-positive patients; the mean age was (48 ± 22) years old. The 217(65%) came from farmer in the developed group, and the other 117 cases came from other occupations (35%). The 289 (87%) cases came from Shandong Province in 334 positive patients, the 45 cases (13%) came from other province of Province. Chi-square test method was used to analysis the differences of incidence of fungal keratitis among the four seasons using SPSS11.5. CONCLUSIONS: The Fusarium is the most important pathogen in fungal keratitis in Shandong Province. The high positive culture rate of fungal keratitis specimens plays an important role in clinical diagnosis and treatment.
