| Objective To evaluate the outcome of keratoplasty for the treatment of fungal keratitis.Methods We choosed 32 patients(32 eyes) with fungal keratitis which had been treated for keratoplasty in our hospital from 2000 to 2006. The follow-up ranged from 6～36 months.The postoperative visual acuity, transparency of transplant and complications were documented. 22 cases were males and 10 cases females. The age was from 29 years old to 70 years old and the average was 45 years old. 22 cases engaged in farm work ,and 9 cases engaged in others jobs , the other 1 case engaged in office. 15 eyes(55.6%) were hurt by plant,5 eyes(15.6%)were hurt by other things, 12 eyes (37.5%)can not refer obvious causes.The course of disease was from 12 days to 3 months. The range of visual acuity was from light perception to 0.15, 10 eyes(31.3%) in light perception,9 eyes (28.1%) in hand movement , 5 eye(s15.6%) in counting fingers,6 eyes(7.4%) from 0.05 to 0.1 and 2 eyes (9.4%) over 0.1.The cornealinfiltrateion size was 10 eyes(31.3%) over 8mm. 17 eyes(53.1%) had hypopyon,16 eyes(50.0%) had synechia of iris , 13 eyes(40.6%) had iris neovascularization,11 eyes (34.4%) had secondary glaucoma, 10 eyes ( 29.6% ) had corneal neovascularization and 5 eyes(15.6%) had corneal perforation. All patients'scrapings showed the fungal hyphae by 10% potassium hydroxide.22 eyes were treated by partial penetrating keratoplasty (PPK),4 eyes were treated by total penetrating keratoplasty(TPK), 2 eyes were treated by lamellar keratoplasty, 1 eye was treated by total cornea with circular lamellar sclera transplantation , 3 eyes were treated by using lamellar grafts with lamellar sclera and 9 eyes were treated by multiple surgical procedures.Result All of 32 patients with fungal keratitis had conserved eyeball after keratoplasty.The visual acuity was improved to various extent in 30 eyes(93.8%)and was not altered in 2 eyes(6.2%).32 eyes(100.0%) recovered from the first operation and 4 eyes (12.5%) were recurrenced fungal keratitis. All of 4 eyes were performed by penetrating keratoplasty. The recurring time was 4～23 days and the mean recurring time was 13.0 days.3 eyes of the 4 ones were eccentric graft. The corneal infiltrateion size of 4 eyes was over 8mm and the infiltrate depth reached whole corneal thickness. All of 4 cases were healed. There were all occurred rejection after penetrating keratoplasty .The time of immune rejection is from 17 days to 30 months, averaing 137.0 days. The rejection of multiple was 3 eyes(23.1%). The peak of immune rejection of fungal keratitis occurred within 1～6 months after surgery. The immune rejection occurred earlier in the case of large graft size. 75.0% occurred within 3 months after surgery. The rate of immune rejection of eccentric graft was55.6% and graft in the center was 30.8%.The rate of immune rejection with corneal neovascularization was 50.0%, with secondary glaucoma was 45.5%, with synechia of iris was 43.8%. All of 13 eyes were healed by drug treatment.4 eyes(12.5%) had secondary glaucoma after surgery. The intraocular tension of 2 eyes were controlled by drug treatment. 7 eyes(21.8%) of patients were occurred complicated cataract.2 eyes were extracted lens in surgery.27 corneal grafts(84.4%)were transparent,4 grafts(12.5%)were semitransparent and 1 graft(3.1%) was nubecula .Conclusion 1.The keratoplasty is an effective approach for fungal keratitis.It could remove focus of infection,control infection,shorten recover time, improve visual and conserve eyeball. 2.Keratoplasty is measured when the curative effect of drugs were insensitivity or inefficacy.It could decrease complications.3.The main complications were recurrenced fungal keratitis,immune rejection and secondary glaucoma. It could decrease the serious result of complications by early treating.4.The recurrenced fungal keratitis occurred within two weeks. It could decrease the damage of eyeball by treating promptly.5.The risk factor for graft rejection were preoperative and postoperative inflammatory reaction , preoperative corneal neovascularization, large graft size,synechia of iris and secondary glaucoma. |
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