| Objective:Retrospective analysis of fungal keratitis caused by three commonfungi genus, include different clinical characteristics, pathogenic risk factors,treatment outcomes and other related features. To provide a more objective basis forearly diagnosis and treatment of fungal keratitis.Methods:There were203cases of fungal keratitis(fusarium,aspergillus,alternaria)with complete information in Shandong Eye hospital from January2007to June2011,excepted the cases with local or systemic use of glucocorticoid drugs.Analysis the following characteristics:(1) The characteristics of susceptible populations:1) Sex: male, female,2)age:≤20years old,21to40years old,41to60years old,≥60years old.3)Occupation:peasants, workers, students, unemployed, other, analyzed the distribution of thesefeatures in different genus;(2) Infected risk factors: trauma (plant, fans eyes, iron foreign body), ocularsurface disease (sufferred with eye disease previously, eye with postoperation, eyewith long-term use of antibiotics), history of contact lens wear, unknown reasons,analyzed the differences between different genus risk factors of infection characteristics.(3) Infected clinical features:included pseudopodia, and satellite lesions, hyphae,moss, endothelial plaque and immune ring, hypopyon, analyzed the following aspects:1) the different distribution of clinical characteristics,2) the different distribution ofclinical characteristics in different genus and the differences.3) divided the groupsaccording to the infection course of the disease (the time of symptoms from onset todiagnosis):≤1week,1week to2weeks,≥2weeks, to analyzed the different change ofclinical features in different course and the difference genus,4) divided the groups bythe different treatment before the diagnosis: anti-fungal treatment, unanti-fungaltreatment, unknown treatment, analysed the difference of clinical features withdifferent treatment conditions.5) the infected lesion areas in diverse species; theinfected lesions in diverse species with different courses, divided into three groups bythe diameter of3~5mm (≤10mm~2,10~20mm~2,20mm~2), compared the differencesin diverse species.(4) The treatment outcomes and recurrences: including simple drug treatment,excision, conjunctival flap covering, lamellar keratoplasty, penetrating keratoplasty,the eye contents enucleation or eye enucleation,1) to analyze the distribution indiverse species,2) analysis of the clinical features of different treatment,3) analyzedthe recurrence in diverse species.(5) Complications: complicated with bacterial infection, secondary glaucoma,corneal perforation. Use SPSS17.0statistical analysis software, the chi-square testwas used to compare the infected clinical features, independent sample t-test toanalyse the infected lesion areas.Results: There were151cases of Fusarium infection,35cases of Aspergillusinfection,17cases of Alternaria infection.(1) The characteristics of susceptible populations: males accounted for66.89%to78.57%, females accounted for23.53%to33.11%; age mainly distributed from41to 60years old, accounting for54.97%to88.24%, followed by21~40years old, about26.49%to34.29%; the occupational distribution was farmer, about60%to80.13%.(2) Infected risk factors: cause the mainly risk factors was trauma (71.92%) inthree genus, followed by unknown causes, about21.67%. There were72.19%and19.87%in Fusarium, approximately74.29%and22.86%in Aspergillus, and about64.71%and35.29%in Alternaria. It had differences in history of trauma betweendifferent genus (P=0.015), which, Fusarium and Alternaria mainly with plant history,respectively46.38%and63.64%, followed by the history of fans eyes, accounting for40.37%and36.36%; Aspergillus mostly caused by the history of fans eyes (53.85%),followed by plants and iron foreign body trauma history, account for19.23%.(3) Clinical features of infection: the different genus had a statistically significantcorrelation with clinical features (P <0.000).1) The distribution of different clinical characteristics: pseudopodia (67.98%),hypopyon (38.92), satellite lesions (27.59%), moss (20.20%), endothelial plaques(10.84%) and immune ring (8.37%).2) The clinical features in the different genus had significant statisticallydifferences (P <0.000). Fusarium had the mainly features of pseudopodia (74.17%),hypopyon (39.07%),and satellite lesions (31.13%), hypopyon (51.43%), moss(45.71%), endothelial plaque Fusarium (42.86%),and pseudopodia (42.86%) inAspergillus, and pseudopodia (64.71%), hypopyon (11.76%), and satellite lesions(17.65%) in Alternaria, of which Aspergillus had statistically significant differeceswith the others genus (P <0.05), the occurrence of satellite lesions and pseudopodia inFusarium were higher than Aspergillus and Alternaria, Aspergillus had lowerincidence; the occurrence of moss, endothelial plaque and immune ring, hypopyon inAspergillus were higher than the other two genus,Alternaria had lower incidence.3) There were had significant correlation of the treatment time and clinicalfeatures in Fusarium(P=0.000). Pseudopodia (70.64%to83.33%), satellite lesions (33.33%to44.44%)were the most common clinical features in Fusarium, when thetreatment time was over2weeks, the hypopyon increased, had pseudopodia (70.64%),satellite lesions (43.12%), hypopyon (46.79%), There were no difference in the courseof the clinical features Aspergillus, and Alternaria(P=0.446).4) According to the different treatment, there were no statistically difference offeatures in three genus (P>0.05).5) Infected lesion areas: the average was18.21±15.27mm~2in Fusarium withaverage14.63±14.73mm~2in Aspergillus, average16.29±33.66mm~2in Alternaria,with no difference (P=0.523). It had statistically difference in the infected lesionswhen the course more than two weeks(P=0.004), which Fusarium was biggest(18.02±15.01mm~2), Alternaria was minimum (6.20±5.07mm~2);the lesion area distributionhad no significant difference in three kinds (P>0.05), less than10mm~2,39.07%and48.57%in Fusarium and Aspergillus, Alternaria had about64.71%. greater than20mm~2,37.09%and32.43%in Fusarium and Aspergillus, Alternaria had11.76%.(4) The treatment outcomes and recurrence:1) PKP and LKP were the mainly treatment method. PKP accounted for40.40%,51.43%,23.53%in Fusarium, Aspergillus and Alternaria, LKP accounted for31.79%,20%,17.65%, drug therapy were8.61%,5.71%,17.65%, excision cured accountedfor5.30%,5.71%,11.76%, evisceration accounted for5.96%,2.86%,5.88%,Aspergillus with PKP was higher than the other two genus, Fusarium LKP was higerthan the other two genus. Alternaria with drug treatment and excision were higherthan the other two genus.2) The cure methods and clinical features: there had statistically significantcorrelation between different cure methods and clinical features(P=0.001). PKP andLKP had difference (P=0.001), LKP was mainly with the pseudopodia, satellitelesions, PKP was mainly with the hypopyon and endothelial plaque.3) Recurrence:9.93%of postoperative recurrence in patients with Fusarium, of which66.67%was PKP,5.71%of Aspergillus with postoperative recurrence, both ofthe LKP.(5) Complications: complicated with bacterial infections: Fusarium13cases(8.61%),3cases (8.57%) in aspergillus. With corneal perforation: Fusarium7cases(4.64%),2cases (5.71%) in Aspergillus. With secondary glaucoma:35cases(23.179%) of the Fusarium,10cases in Aspergillus (28.57%),1case in Alternaria(5.88%).Conclusion: In the incidence of risk factors, Fusarium and Alternaria weremainly caused by the plant history of trauma, Aspergillus had the history of fans eyes.Genus differences leaded to different clinical characteristics,of Fusarium andAspergillus progressed faster and heavier, Fusarium had a larger infection area withthe performance of pseudopodia, satellite lesions, with the sicker, the hypopyonincreased. Aspergillus had a heavier infection in early stage, performance ofhypopyon, moss and endothelial plaque, Alternaria had a small infected area,pseudopodia, and satellite lesions was the mainly stable performance. The mainclinical characteristics of the different genus infection, contribute to early clinicaldiagnosis and early targeted treatment. |
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