| Objective:The main objective of this study is to evaluate the epidemiological characteristics,diagnosis,treatment and prognosis of patients with fungal corneal ulcer.Moreover,it also evaluates the relationship between the general situation,basic conditions of patients,medical & surgical treatment as well as clinical outcomes of patients with fungal corneal ulcer,to provide new ideas and basis for clinical diagnosis and treatment.Methods:We collected 143 eyes(143 patients)diagnosed as fungal corneal ulcer by the Bethune First Hospital of Jilin University from January 2017 to June 2018.Once admitted to the hospital,most of the patients received corneal debridement,fungal culture and corneal confocal microscope before treatment.In cases with confirmed diagnosis of fungal corneal infection,proper drug therapy or surgery were performed according to the severity of illness.During hospitalization,the condition of the infected eye was observed daily by slit-lamp biomicroscopy.The patients’ visual acuity(VA),corneal ulcer area,presence of hypopyon and other complications were re-evaluated before discharging from the hospital.Here,we summarized the epidemiological characteristics,fungal culture results and outcomes of the 143 patients in order to analyze factors affecting the prognosis of patients with fungal corneal ulcer.Results:1.Among the 143 patients with fungal corneal ulcer,85 patients(59.44%)weremale and 58 patients(40.56%)were female.Among the male patients,4 were cured and 78 were improved,with a total effective rate of 96.47%.Among the female patients,4 were cured and 53 were improved,and the total effective rate was 98.28%.The comparison showed that there was no statistically significant difference in the efficacy between different genders(Z=0.808,P=0.419).The average age of the patients was59.86±10.40 years.There were 33 patients from urban area(23.08%)and 110 patients from rural area(76.92%).As for the patients’ profession,there were 7 civil servants,79 farmers,16 patients were jobless and 41 were engaged in other professions.Among the patients form urban area,5 cases were cured,28 cases were improved,the total effective rate was 100.00%.And for the patients from the rural area,only 3 patients were cured,treatment was ineffective in 4 patients,the total effective rate was 96.36%.Furthermore,the results showed that the curative effect of urban patients is better than that of urban patients,the difference was statistically significant(Z = 2.806,P = 0.005).The comparison of curative effect of patients in different occupations showed that the curative effect of public servants was better than that of other occupations,and the difference was statistically significant(H=42.200,P<0.001).2.The course of fungal corneal ulcer was less than 1 month in 102(71.32%)patients,longer than 1 month in 41 patients(28.68%).And the results had shown that the curative effect of the patients whose course were less than 1 month were better than those patients whose course were longer than 1 month;the difference was statistically significant(Z=1.997,P=0.046).58 patients(40.56%)were admitted with hypopyon,and no statistically significant difference was found between patients with hypopyon and absence of hypopyon(P>0.05).32 patients(22.38%)were complicated with iridocyclitis,6 patients(4.20%)were complicated with endophthalmitis,and 4 patients(2.80%)were complicated with corneal ulcer perforation.The average ulcer area was4.72±1.81 mm.By comparison,the curative effect of patients without complications(iridocyclitis,corneal ulcer perforation and endophthalmitis)was better than those patients with complications,the difference was statistically significant(Z=2.001,P=0.045).3.118 patients who underwent in vivo confocal microscopy(IVCM),99 of them were positive for mycelia with a positive rate of 83.90%.A total number of 75 patients underwent fungal culture and the positive results were in 40 cases,with a positive rateof 53.33%.Among the patients with positive fungal culture,there were 28 cases(70.00%)infected by fusarium,7 cases(17.50%)infected by aspergillus,and 5 cases(12.50%)infected by streptosporium.4.122 cases(89.05%)were treated with corneal ulcer debridement,followed by corneal intrastromal injection in 45 cases(32.85%),with a total effective rate of 100%,amniotic membrane transplantation(AMT)in 20 cases(14.60%),with a total effective rate of 100%,and corneal collagen cross-linking(CXL)in 16 cases(11.19%),with a total effective rate of 100%.Conclusion:1.Fusarium and aspergillus are the main pathogenic organism in patients with fungal corneal ulcer in Jilin province and surrounding areas.2.Middle-aged and elderly male engaged in agricultural work are among major risk group for fungal corneal ulcer,hence the basic education of fungal corneal infection to vulnerable groups should be strengthened.3.In vivo confocal microscopy(IVCM)is a non-invasive,rapid and effective method in patients with fungal corneal ulcer to follow changes of infected eyes.Besides this its detection rate is higher than fungal culture.4.In order to improve the prognosis of patients,appropriate drugs and surgical treatment should be selected according to the patient’s condition,and intervention should be carried out as soon as possible. |
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