Clinical Observation And Analysis Of The Quadruple Surgery And The Second Phase Keratoplasty In Severe Infectious Keratitis Patients

Part I Clinical Observation and Analysis of the Quadruple Surgery in Severe Infectious Keratitis PatientsObjectiveTo observe and analyze the therapeutic effect of quadruple surgery, and to evaluate the clinical value of quadruple surgery and timely operation intervention in severe infectious keratitis patients. MethodWe collected 72 cases(72 eyes) of severe infectious keratitis patients in Affiicated Eye Hospital of Nanchang University from June 2012 to December 2015, and carried out quadruple surgery, keratohelcosis debridement combined anterior chamber douche combined anterior chamber injection combined conjunctival flap covering surgery. 30 bacterial keratitis, 30 fungal keratitis and 12 mixed keratitis were include, of which 18 eyes with corneal perforation, 58 eyes with more than 1/3 anterior chamber volume empyema, 62 eyes with maximum corneal ulcer diameter over 5 mm. All of the patients were performed quadruple surgery. Post-operation follow up was carried out for 3 months to observe the preservation of eyeball, best corrected visual acuity(BCVA), and infection recurrence. SPSS 19.0 software was implied to statistical analysis the pre- and post-operation BCVA. Result1. 97.2%(70/72eyes) patients’ infection were successfully controlled and eyeballs were preserved.2. The pre- and post-operation BCVA has statistical significance, post-operation BCVA was better than the pre-operation BCVA.(Χ2=0.8958,P=0.030)。ConclutionQuadruple surgery is an effective therapy in severe infectious keratitis, and has profound significance in preserving eyeball of sereve infectious keratitis patients.Part II Therapeutic Effect Comparison of the Second Phase Keratoplasty after the Quadruple Surgery and the First Phase KeratoplastyObjectiveTo observe and compare the change of BCVA, infection recurrence, corneal graft rejection, and other complications respectively post operation of the second phase keratoplasty after the quadruple surgery and the first phase keratoplasty. MethodWe choosed 70 eyes with severe infectious keratitis successfully controlled through the quadruple surgery, and performed the second phase keratoplasty. While the first phase keratoplasty were carried out in 40 eyes with severe infectious keratitis as the control group, which include 22 eyes with bacterial keratitis, 16 eyes with fungal keratitis and 2 eyes with mixed keratitis. 3 months’ post-operation follow-up was investigated to observe the change of BCVA, infection recurrence, corneal graft regection and other complications. The SSPA 19.0 software was implied to analysis the statistic significance of the pre- and post-operation BCVA. Result1. There was no infection recurrence in the 70 eyes which were performed the second phase keratoplasty after the quadruple surgery, while 8 eyes with the first phase keratoplasty recurred infection. There was statistic significance in infection recurrence between two groups(Χ2=15.098,P<0.001), the infection recurrence rate in the study group is lower than the control one.2. In the group with the second phase keratoplasty after the quadruple surgery, in pre-operation there were 63 eyes with BCVA worse than 0.02, 34 of which with hand move before eye, 29 with fingure count/10 cm. BCVA of the first day post-operation were showed 19 eyes with fingure count/10 cm, 43 eyes among 0.02 to 0.1, 6 among 0.1 to 0.3, and 2 eyes were better than 0.3. BCVA of 3 months post-operation were turned out that 9 eyes with fingure count/10 cm, 28 among 0.02 to 0.1, 15 among 0.1 to 0.3, and 12 eyes were better than 0.3. In the group with the first phase keratoplasty, pre-operation with 36 eyes’ BCVA lower than 0.02, 3 eyes of which were light perception, 23 were hand move before eye, 10 fingure count/10 cm. BCVA of the first day post-operation were displayed 33 eyes with fingure count/10 cm, 6 among 0.02 to 0.1, 1 eye was 0.2. BCVA of 3 months post-operation were turned out that 7 eyes with fingure count/10 cm, 15 among 0.02 to 0.1, 8 among 0.1 to 0.3, 5 were better than 0.3.3. The corneal graft rejection rate was 8.6%(6/70 eyes) in the group with the second phase keratoplasty after quadruple surgery, much lower than the rate 10%(4/40 eyes) of the control one with the first phase keratoplasty. The BCVA in the group with the second phase keratoplasty after the quadruple surgery was better than the control one with the first phase keratoplasty in short-term post-operation(Χ2=40.632,P﹤0.001),while no statistic significance in 3 months post-operation(Χ2=0.589,P=0.443).4. 30 eyes(30/70,42.8%) appeared complications in the group with the second phase keratoplasty after the quadruple surgery, including 3 eyes with secondary glaucoma, 21 with complicated cataract, and 6 with secondary glaucoma and complicated cataract simultaneously. In the control group 17 eyes(17/40,42.5%) had complications, 1 eye with secondary glaucoma, 9 with complicated cataract, and 7 with secondary glaucoma and complicated cataract concurrently. There was no statistic significance between the two groups(Χ2=0.754,P=0.385). Conclution1. The infection recurrence rate in the group with the second phase keratoplasty after quadruple surgery was lower than the control one with the first phase keratoplasty.2. The BCVA in the group with the second phase keratoplasty after quadruple surgery was better than the control one with the first phase keratoplasty in short-term post-operation,while no statistic significance in long-term post-operation.3. The corneal graft rejection rate in the group with the second phase keratoplasty after quadruple surgery was lower than the rate the control one with the first phase keratoplasty.4. There was no difference in complication occurrence between the group with the second phase keratoplasty after quadruple surgery and the control one with the first phase keratoplasty.