| Backgroud:Fungal keratitis has been serious hazard which can result in blindness in our country, in particularly occur in developing countries which are mainly in agricultural economy. With the recent years clinical antibiotics and corticosteroids abusing, contact lens use of the crowd increasing, widely used immunosuppressant drugs and other reasons, its incidence has gradually rise. Now in China, statistics have showed fungal keratitis accounted for the first place (approximately 34.8%-61.9%) of the infectious keratitis. Thereby improving the clinical diagnosis and treatment of fungal keratitis has great significance for the prevention of blindness.Objective:This paper carried out the epidemiological characteristics of 48 cases fungal keratitis patients, as well as the test results, and treatment outcomes retrospectively analyzed to investigate the disease characteristics of the treatment during hospitalization and to evaluate clinical effect, and to provide evidence for leading clinical use in future and selection of treatment strategy.Method:From 2011 to 2015 in ophthamologic department with suspected fungal corneal ulcer,48 cases (48 eye) resident patients were retrospectively analyzed.The 1st day patients admitted to hospital, firstly we check corneal confocal microscopy(IVCM)、corneal scrapings microscopy、fungal culture and subsequently treat with conventional antifungal drugs,.DO slit lamp examination everyday, and about one week to review confocal microscopy. Observe corneal ulcer lesions during treatment and contrast its changes in range, depth and number of hyphae, hypopyon and epithelial healing. Summarized the epidemiological characteristics of 48 patients, and the test results, treatment outcomes, etc., in order to evaluate characteristics of the disease and response to treatment effect during hospitalization.Results:In 48 cases,30 were males and 18 females, male to female ratio is 5:3; We find the mean age is 47.8 years, with most (17 cases,35.4%) of patients in the 40-49 age group,50-59 age group second (10 cases,20.1%); As to the occupational factors, farmers 37 cases, accounting for 77.1% of all patients; the history of corneal trauma of plant account the most inducement (19 cases,39.6%), secondary to other eye diseases and patients with penetration keratoplasty are 8 cases in all. After admission,48 patients with confocal microscope to find hyphae, the positive rate is 100%,when corneal scraping endoscopy in 31 cases(positive rate 64.6%)、fungal culture examination in 7 cases (positive rate 14.6%),in which there are 5 cases of Fusarium, Aspergillus 2 cases,without other pathogenic genera.With 1 week treatment 27 cases reviewconfocal microscopy has 18 cases positive (found hyphae), the average depth of hyphae invasion before treatment was 137.1 um, after treatment, the average depth was 109.4um, with an reduction of 27.7um. Applications with voriconazole and fluconazole, natamycin, amphotericin B in treatment, we found that the average hospital days for all patients was 14.6 d (median 12 d, the mode 7-8 d), in which the 1-2w group in 21 cases (43.8%),2-3w 11 cases (22.9%), and less than 1w in 4 cases (8.3%), more than 4w in 5 cases (10.4%).In all patients 39 cases (81.25%) improved and discharged,9 patients with corneal perforation due to serious illness and take the opration of PKP or LKP. The relationship between disease’s severity and hyphae depth by confocal microscopy has significant difference statistically (P<0.05), that can conclude the correlation between the two factors.And whether patients with hypopyon associated with depth of invasion hyphae,we find P> 0.05, meaning hypopyon does not determine the severity of the diseases. In the same way,the severity and duration of hospital days were significantly different(P<0.05), can inferr that the more severe the disease is, the time spent in hospital is longer, the worse the response to chemotherapy. Conclusion:Fungal keratitis has been a common cornea infection clinically, its early diagnosis and treatment is important. Confocal microscopy diagnosis of fungal keratitis is efficient, specific and effective as a means of non-invasive diagnostic techniques, high positive rate, easy operation and dynamic real-time assessment.it plays an important role in evaluating clinical efficacy in early clinical diagnosis of fungal keratitis, treatment and prognosis. Hyphae depth of invasion and disease severity were correlated, and whether with hypopyon or not has no significant correlation with the depth of mycelium. All patients with an average length of days about 2w in hospital, and most patients with conservative treatment can be clinical cured. The clinical characteristics of the disease and treatment outcomes may provide evidence for the efficacy of treatment feedback, guide and lead the actual clinical dose adjustment, which may be important to carry out more research to reduce the length of hospital days and improve treatment levels. |
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