Clinical Researches On Suppurative Keratitis

Suppurative keratitis is one of common ocular infectious pathologies. It has a high incidence in developing countries or regions. It is one of the most visually threatening diseases. In our country, suppurative keratitis has usually been the second cause of blindness after cataract. Suppurative keratitis can also be influenced by climatic,geographic,sanitary and microbic factors. In recent years the literature of suppurative keratitis are main concentrated on developed regions in eastern china, but only few publications reviewed suppurative keratitis in western china. Because ChongQing is a poor health and economic conditions region, there has a high incidence of suppurative keratitis. Very little information is available on clinical characteristic of those patients. Therefore, it is important for us to collect and analysis patients of suppurative keratitis. The primary purpose of this investigation has be helpful to ophthalmologist. This study includes two parts:part one, clinical analysis of 282 suppurative keratitis cases in chongqing;part two, clinical research on operative therapy for refractory suppurative keratitis. Part oneObjectiveThrough to analyze the pathogens, antibiotic resistance, clinical features and prognosis of suppurative keratitis in affiliated first hospital, Chongqing Medical University. The summary experience, in order to improve the diagnosing and managing level.MethodsA retrospective analysis of the hospital records of patients presenting with suppurative keratitis and treated at the first affiliated hospital, Chongqing Medical University, from March 2001 to March 2009.χ2 test was used to analysis the patients'characters between risk factors,pathogens,antibiotic resistance and prognosis.Results1,Predisposing:Corneal trauma was the main risk factors(39.0%). Following have co-existing ocular diseases(11.0%), Systemic risk factors(9.2%), Soft-contact lens wear(8.2%).2,Pathogens and antibiotic resistance:Nosogenic positive have 115 eyes(45.3%), among the positive cases, pure bacterial infections had 59.1%, pure fungal infections had 32.2%, mixed infections had 8.7%. Staphylococcus spp shown a high resistance to antibiotic, in addition to rifampicin and vancomycin. Gram negative bacterium had a remarkable resistance to erythromycin and ampicillin. 3,Clinical features:Most of bacterial keratiti(s74%)presented serious irritation symptoms(>2分), but there have 5 cases of fungal keratitis, presented serious irritation symptoms(>3分);Fungus was predominance pathogens in the hypopyum and corneal perforation cases. Most pathogens in mixed infections were mycetes+Staphylococcus epidermidis. 70% cases of mixed infections were exceed over 50 years.4,Prognosis:In this study, effective rates was 78.1%, and blind rates was 12.8%. There was significant statistical difference in cure rate between operation group and medicine group(P<0. 05).When ulcer diameter exceed 6mm or hypopygum, the prognosis of patients were get worse.Part twoObjectiveTo evaluate the surgical timing,indications,complications and clinical effect after operative therapy for refractory suppurative keratitis.MethodsWe choosed 85 patients(85 eyes)with refractory suppurative keratitis which had been treated for operative therapy at the first affiliated hospital, Chongqing, from Mar. 2001 to Oct. 2008. Regular communicate with patients of post-discharge by review, telephone or message. The follow-up was over 6 months regularly. Complications and clinical effect were observed.χ2 test was used to analysis parameters. Results78 cases(91.8%) completed the follow-up. Postoperative visual acuity had a remarkable raise. During the postoperative follow-up, 5 eyes operation were failure and ophthalmectomy at last. In this study, effective rates was 93.6%, and cure rates was 75.6%. Postoperative complications included infectious recurrence( 9 eyes, 11.5%), secondary glaucoma( 8 eyes, 10.3%), complicated cataract( 13 eyes, 16.7%) and immune rejection( 21 eyes, 26.9%). Most of complications were recovery by active treatment.Conclusion1,This study revealed that corneal trauma was the main risk factors in suppurative keratitis. Bacterium was still predominant pathogenic microorganism. There has a increasing tendency to antibiotic resistance.2,In this investigation, majority patients consist with typical clinical manifestation. But there had some new changes:Fungal keratitis could also presented serious irritation symptoms ; Fungus was predominance pathogens in the hypopyum and corneal perforation cases;Mixed infections has a increasing tendency, which occur in aged-people and worse prognosis.3,Most of suppurative keratitis could conserve eyeball and improve visual by the effective management. Prognosis connected with clinical signs,treatment policy and pathogen types. 4,The operative therapy is an effective approach for refractory suppurative keratitis. Through to timely operation and regular follow-up, patients can decrease complications and raise cure rates.5,Although all cases in this study came from ChongQing and suburban regions, multi-center and large scale investigations are still needed to further evaluate the characteristics of suppurative keratitis in Chongqing.