The Analysis Of Diagnosis And Treatment Of Fungal Keratitis

Objective: To evaluate the laboratory diagnostic methods and to analysis the etiological characteristics and treatment effect of the fungal keratitis, aimed at helping the diagnosis and treatment of fungal keratitis.Method: We chose 85 cases diagnosed fungal keratitis which had been treated in our hospital from January 2007 to December 2008. All the patients came from Jilin Province. 52 cases(61.2%)were males, and 33 cases(38.8%)were females, male to female ratio was 1.58:1. The age was from 20 years old to 71 years old and the average age was 46 years old. Right eye was 40 cases (47.1%), left eye was 45 cases(52.9%). Farmer was 53 cases (62.4%). 48 cases (56.5%) had crops traumatic history which covered corn leaf, etc. The corneal ulcer organizations was scraped under operating microscope after the ocular superficial anesthesia for which 0.4% hydrochloric acid oxybuprocaine was used .Part of the scraping material was spread onto glass slide, and covered with cover slip after plus one drop of 10% potassium hydroxide. Fungal hyphae or spores were searched under the microscope. The rest of the corneal ulcer organizations was put in a sterile centrifuge tube with a small number of sterile normal saline and send it to the teaching and research section of mycology. The fugal was cultured and identified by professionals. Compare the results of two laboratory examination, and classified the fungal pathogens; All patients were classified according to severity and were given 0.5% fluconazole eyedrops united 5% Natamycin eyedrops to drip eyes, depending on the conditions to change the frequency; The moderate and severe patients were given 100ml 0.2% fluconazole injection, 1-2 times one day; The patients who were invalid with antifungal drugs, or corneal ulcer size enlarged, or corneal ulcer had tended to perforate or the perforation had occurred were operated conjunctival cover or penetrating keratoplasty. The patients with high intraocular pressure were combined with anti-glaucoma surgery. Compare the therapeutic effect of varying degrees of fungal keratitis.Results:1,85 samples were all examined by 10% KOH wet mount method, of which 52 cases were positive, 33 cases were negative, the positive detection rate was 61.2%; 57 samples were examined by fungal culture, of which 37 cases were positive, 20 cases were negative, the positive detection rate was 64.9%; There was no significance in difference between 10% KOH wet mount method and fungal culture method for positive rate of detecting fungi (χ2 = 0.17, P> 0.05); With fungal culture method as a standard, the sensitivity of 10% KOH wet mount method was 89.2%, the specificity was 90%. 2,40 strains pathogenic fungi was identified in 37 samples, of which the main pathogenic spectrums were Fusarium species (19 cases, accounting for 47.5%), Aspergillus species (8 cases, accounting for 20%), Candida species (5 cases , accounting for 12.5%); the main organisms cultured were Fusarium solani (14 cases, accounting for 35%), Aspergillus fumigatus (6 cases, accounting for 15%). 3,The treatment for 17 cases of mild fungal keratitis with drug was in full force and effect, which effective rate was 100%. The total effective rates of the treatment for moderate and severe keratitis were 87.5% and 54.5% respectively, there was significance in difference (χ2=4.39,P<0.05); The effective rates of simple drug treatment group and united surgery group were 55.8% and 84.0% respectively, there was significance in difference (χ2=7.81, P<0.01).Conclusion: 1,potassium hydroxide (KOH) wet mount method is the earliest method which is used to check fungi under the microscope directly, which method uses the function that potassium hydroxide can dissolve the non-fungal impurities in the cornea or secretions and then show hyphae or spores. KOH wet mount method can be used as a simple and effective laboratory methods of the early diagnosis of fungal corneal ulcer because it has the advantages of simple,fast, the reliable results, low-cost, master easily et al. 2,Because of the differences of productivity,living standards,the proportion of population,climate,geographical conditions in different regions and countries, the species of corneal pathogenic fungi are also different, Fusarium species, especially Fusarium solani has become the primary pathogenic fungi of fungal keratitis in JiLin province. 3,Simple drug treatment can achieve satisfactory effect for the early,mild fungal keratitis, but the whole curative effect of the severe fungal keratitis is worse than the moderate. Therefore, early diagnosis and treatment to the fungal keratitis can control the condition effectively and improve the cure rate. 4,The moderate and severe patients have poor effect through drug therapy alone, surgery can improve the efficiency of treatment. Therefore, the reasonable application of drug therapy and surgical treatment for the moderate and severe patients of fungal keratitis is essential.