The Non-surgical Therapy Of Fungal Cornea Ulcer

The fungal keratitis is caused by the infection directly with the result that a fungi to invade the cornea , which is a kind of serious eye disease with the blindness. This disease was reported by Dr. Leber first in 1878. Because the outbreak rate is not high, the fungal keratitis was mentioned less on the literatures.50 age later, because of the extensive application of the antibiotics and hormone, and the exaltation of examine level , the domestic and international reports increased gradually. In the last 10 years, this disease also has to increase obviously in China. Between 2001 and 2004 , 68 consecutive (68 eyes) of the fungal cornea ulcer inpatients coming from different parts of north eastern China were seen in China-Japanese union hospital , we summarized the curative effect of the various non-surgical oper-ations to the fungal cornea ulcer. Analysis of sex , age , pathogeny , job, course of disease , the depth and area of the ulcer and infil-tration , ocular complications , visual acuity of pretreatment and post-treatment was carried out .The all cases was diagnosed by clinical symptom and laboratory examination. Altogether 39 cases were males, and 29 cases females . The youngest patient was 19 years old while the oldest was 74 years old , the average age was 45 years old. The countymen were 49 cases, the other was 19 cases . The Cause of disease: the 32 cases of the plant scoring, the 11 cases after the corneal foreign body taken out, the 1 case of electric shock , the 24 cases have no obvious cause . Before seeking the medical advice, 46 cases used antibiotics , 21 days averagely . Before seeking medical advice the course of illness was from 5 days to about 3 months, average course was 24 days .The clinical symptom of all cases were all photophobia , lacrimation , foreign body sensation and ache, etc. The range of optimal corrected visual was from light perception to 0.5, the 12 eyes in light perception, the 32 eyes in hand movement , 10 eyes in counting fingers, 7 eyes in 0.02～0.1, 6 eyes in 0.1～0.3, 1 eyes in 0.3～0.5. The corneal infiltrateion size: 6 eyes under 4mm,13 eyes in 4～6mm ,21 eyes in 6 ～8mm , 28 eyes over 8mm. The infiltrate depth reached superficial stroma 3 eyes ,deep stroma 46 cases , the whole corneal thickness 19 eyes. Of the 68 eyes,21 eyes had the secondary glaucoma, 35 eyes had the complicated iridocyclitis, 29 eyes had the hypopyon, 26 eyes had corneal neovascularization. All sufferers have no the systemic diseases. All patients'scrapings showed the fungal hyphae by 10% potassium hydroxide. The therapy methods adopted: topical and systemic drug treatment and surgical operation. 2 cases which the lesion were under 4mm ,merely involved the superficial stroma and without complications were treated with topical 1 antifungal agent:fluconazol 0.5% eye drops were given once per hour ,change the frequency according to the conditions. 2 cases which the lesion were under 4mm, involved the deep stroma and without complications were treated with topical multi-antifungal agents: natamycin 5% and fluconazol 0.5% eye drops were combined. 64 cases which the lesion were over 4mm, involved the deep stroma or the whole corneal thickness with the complications were treated the topical and systemic application of the anti-fungi medicine: itraconazole capsule took orally 200 mg everyday, fluconazol 0.5% eye drops were applied. Meanwhile 16 cases of these were managed with fluconazol 0.2% systemically and sub-conjunctival injection and natamycin 5% eye drops. Other meatures: the most fungal keratitis had the complicated iridocyclitis, so all 68 cases were applied 1% atropin ointment to cause dilatation of the pupils. 21 cases which had the secondary glaucoma were treated with Timolol 0.25% eye drops and Diamox 0.25 orally. 7 of 21 cases were applied Mannitol 20% systemically. Trabeculectomy were managed to 7 cases whose intraocular tension didn't lower the normal level by drugs. Meanwhile 68 cases took the vitamin,the non-steroidal anti-inflammatory drugs orally and adjunctive therapy with the hot compress, ultraviolet ray, etc. The corneal focal was cleaned and eroded : after the surface anaesthesia by 0.4% oxybuprocaine hydrochloride, the necrotic organization and...