| ObjectiveTo study the application value of IVCM for fungal keratitis,summarize its unique advantages and current limitations by combining clinical diagnosis and treatment process and comparing with traditional examination methods.The etiological causes,disease characteristics and course of fungal keratitis were summarized,and the indications,clinical efficacy and prognosis of different treatment schemes were analyzed and discussed,so as to provide guidance and reference for the selection of clinical diagnosis and treatment methods of fungal keratitis.MethodsSeventy-seven eyes of 77 patients with fungal keratitis hospitalized in our hospital from August 2019 to January 2022 were selected as the study subjects.Before systemic antifungal therapy after admission,all patients underwent laser confocal microscopy（IVCM）,as well as routine ophthalmic examinations such as slit-lamp,visual acuity,i OP and fundus,and IVCM was reviewed again when their condition changed and at discharge.Summarize the medical records,summarize the patient’s gender,age,occupation,etiology,history of present disease,and analyze the risk factors;Detailed inquiry and record of the patient’s history and course of disease,analysis of the relationship between pre-admission factors and the condition at admission;The results of IVCM examination were summarized and the positive detection rates of IVCM under different conditions were compared.According to the symptoms,signs and eye specialty under slit lamp,the clinical characteristics of the disease were summarized and the clinical classification was carried out.After classifying the severity of the disease,different treatment plans should be given.The course of the disease should be adjusted timely according to the progress of the disease and the treatment effect,including the dosage of drugs,whether to take surgery and the choice of surgical methods.The changes and healing of corneal lesions were observed during hospitalization,and the clinical efficacy and prognosis of different treatment methods were compared and analyzed.ResultsIn this study,male patients were significantly more than female patients,and patients aged 51-60 years were the most and accounted for the largest proportion,followed by patients aged 61-70 years,and farmers accounted for the majority of patients,who were hospitalized more than in autumn.The main pathogenic reason was the history of plant-based trauma.Pre-admission factor analysis: 1.The relationship between the severity of illness on admission and the time of onset was analyzed,and the comparison between the mild,moderate and severe groups showed P < 0.05,with statistically significant differences（c ~2 = 12.304,P= 0.015）.In other words,there were statistical differences between different groups of illness,so there was a statistical correlation between the time of onset and the severity.2.The relationship between the severity of illness at admission and the treatment before admission was analyzed,and the comparison between the antibiotic group,hormone group and untreated group showed P > 0.05,with no statistical significance（c ~2 = 2.765,P = 0.598）.In other words,there was no significant difference in the degree of illness at admission among the three groups with different interventions.Examination and diagnosis: 1.The positive DETECTION rate of IVCM was slightly higher in the first diagnosis than in the non-first diagnosis（c ~2 = 0.519,P > 0.05）.2.The positive detection rate of IVCM in mild,moderate and severe groups was compared,P > 0.05,that is,the difference was not statistically significant（c ~2 = 1.031,P= 0.637）,and there was no significant statistical correlation between the positive detection rate of IVCM and the severity of the disease.3.The relationship between the positive detection rate of IVCM and the onset time was analyzed.The positive detection rate of IVCM in 3groups of patients with different onset time was compared,and P > 0.05 was obtained,that is,the difference was not statistically significant（c ~2 = 0.49,P = 0.817）.Treatment and prognosis: 1.Comparing the efficacy of simple drug therapy in patients with different conditions,there was statistical difference among mild,moderate and severe drug therapy（c ~2 = 28.435,P < 0.001）.2.According to the specific use of different eye drops,patients treated with simple drugs were divided into two groups:fluconazole eye drops alone group（group A）of 16 cases,fluconazole eye drops combined with natamycin eye drops group（group B）of 21 cases.Comparing the efficacy of group A and group B for fungal keratitis,P< 0.05,the difference was statistically significant（c ~2 = 7.957,P= 0.046）,that is,there was A statistical difference between the two groups.3.In moderate patients,comparing the efficacy of the three regimens of simple drug therapy,lamellar resection of the lesion and amniotic membrane transplantation,P < 0.05 was obtained,with statistically significant differences（c ~2 = 4.267,P = 0.351）,that is,there were statistical differences between the three groups with different treatment methods in terms of efficacy.Further pairization between drug therapy and lamellar resection of the lesion,drug therapy and amniotic membrane transplantation,and lamellar resection of the lesion and amniotic membrane transplantation showed statistical differences,with statistical significance（P < 0.05）.4.In severe patients,comparing the efficacy of the three schemes of simple drug therapy,conjunctival flap occlusion and corneal transplantation,P <0.05 was obtained（c ~2 = 20.844,P < 0.001）,that is,there was a statistical difference in efficacy between the three groups using different treatment methods.There were statistically significant differences between drug therapy and conjunctival flap occlusion,drug therapy and keratoplasty（P < 0.05）.5.In moderate and severe patients,comparing the efficacy of drug therapy alone with that of combined surgical treatment,P < 0.05 was obtained,the difference was statistically significant（c ~2 = 21.061,P < 0.001）,that is,there was a statistical difference between drug therapy and combined surgical treatment in efficacy.Conclusions1.Fungal keratitis mainly affects middle-aged and elderly male farmers,mainly because of plant trauma.2.IVCM plays an important role in the detection of fungi and early diagnosis of fungal keratitis.3.Mild fungal keratitis can achieve better results and prognosis by simple drug treatment.For moderate and severe fungal keratitis,the clinical efficacy and prognosis of drug combined operation are better. |
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