The Diagnosis Treatment And Prognosis Of Fungal Keratitis In The Clinical

Objective: High incidence of fungal keratitis in our country makes lots of person being blind, so early diagnosis and treatment are vital in preventing such disabilities. The purposes of this study are to analyze the clinical characteristics of fungal keratitis infected by different fungal genera, and texplore the Diagnostic methods, prognosis of fungal keratitis i in the clinical,Methods:42cases with fungal keratitis (just single eye) come from QiLu hospital of Shandong university, were analyzed retrospectively, all of them should accepted the routine inspection of ophthalmology at first, then corneal confocal microscope,corneal smears examination and fungal culture in turns, before accepted the treatment. After medicine conservative treatment for5～7days,to decide whether have therapeutic corneal transplantation surgery or not.Then,4weeks later, the patients without therapeutic corneal transplantation surgery should accepted the slit lamp microscopy and corneal confocal microscope,to observe the degree of healing of the corneal epithelium, and if t we could detect fungal filaments. in ulcer focal. At first, we analysis if there are significant statistical differences between the male and female we selecte,such as age, occupation, severity of patient’s condition, treatment method and length of stay, prognosis, etc. Then, we analyze and compare the results of the detection of hyphae and spores by the three methods mentioned before. After that,we grouping the patients by the results of fungal culture,to see if there are significant statistical differences between the groups of fungal keratitis infected by different fungal genera. At last,we grouped the patients to two group by the different intravenous drugs,to compare their curative effects and prognosis.Results:Statistical analysis showed that there are no significantly differences between male and female patients in all of the factors in our study (Table3) that’s just what we expected. In the three methods mentioned before,39cases were detected fungal filaments by corneal confocal microscope, the positive rate is92.86%, corneal smears examination detected29cases, the positive rate is69.1%, while34cases34eyes were detected fungus by fungal culture, the positive rate is81.0%(Table4). Statistical analysis showed that the differences between corneal smears examination and the corneal smears examination were statistically significant (P <0.05), but the differences between others without significant statisticant (Table4). According to the positive results of fungal culture (34cases), we grouping the positive patients into Fusarium group (21cases), Aspergillus group (lOcases), there also other three other fungal genera which both have1cases, the number of samples is too small,we take them out. Statistical analysis showed that, the length of stay and the severty of illness in Fusarium group are significantly higher than that of Aspergillus group, and the healing of the corneal epithelium in ulcer focal by the fourth weeks in patients without therapeutic corneal transplantation surgery is lower than that of Aspergillus group (P<0.05),while other factors without significantly differences.(Table5). By the statistics (Table6), we found no significant differences between the two groups in age, gender, disease severity. For the voriconazole group, the average hospitalization days was shorter than the fluconazole group, and the efficient of medicine conservative treatment for5-7days (76.9%,10/13) was higher than that of fluconazole group (58.6%,17/29). And the corneal transplant patients is only3cases (23.1%), less than12cases of fluconazole group (41.8%). About hospital prognosis, in the voriconazole group, the cure rate was69.2%(9/14), higher than that of fluconazole group48.3%(14/29). while the visual acuity increased accounted for69.2%(9/13), higher than that of fluconazole group41.4%(12/29) when discharged.Conclusions:Corneal confocal microscope is more sensitive than corneal smears examination and more quickly than fungal culture in the diagnosis of fungal keratitis. Voriconazole have better antimicrobial activity against various ocular pathogenic fungi, and its low toxicity, could be the the first choice in the treatment of fungal keratitis.The length of stay and the severty of illness in Fusarium group are significantly higher than that of Aspergillus group, and the healing of the corneal epithelium in ulcer focal by the fourth weeks in patients without therapeutic corneal transplantation surgery is lower than that of Aspergillus group.