The Surgical Therapy Of Severe Infected Cornea Ulcer

The severe infected corneal ulcer is caused by the infection ofpathogens. It is devastating and can cause serious stromal necrosisand hypopyon and difficult to control. Due to the poor effect ofmedication, it can destroy the whole eye ball and lead to blindness.Recently, because of the extensive application of the antibiotics andhormone, and the increasing laborious trauma and the improvementof examine level, the disease has increased obviously in our country.We reviewed 78 eyes of severe infected corneal ulcer inpatientsin China-Japanese union hospital between 2001 and 2005, analyzingthe clinical features and effects of surgical operations with 13months follow-up. We summarized sex, age , pathogen , job, courseof disease , clinical manifestations, ocular complications , visualacuity preoperatively and postoperatively . Among the 78 eyes, 48eyes were fungal keratitis, 6 were bacterial keratitis, and 8 were viralkeratitis. The other 16 eyes couldn't be diagnosed by laboratoryexamination. 51 cases were males, and 26 cases females. Thepatients aged from 4 to 87, averaing 49.4 years old. Averaginghistory was 104.2days. 51cases engaged in farm work ,and 19cases engaged in physical work, the other 7cases engaged in otherjobs . Before the onset of the symptoms, 14 cases were hurt by plant,3 cases were hurt by other things, 3 cases were taken out the cornealforeign body, 57 cases can't refer the obvious causes. Before seekingthe medical advice, 71 cases used antibiotics or hormone, 33 daysaveragely . 8 cases were diabetes,2 cases were diagnosed ofrheumatoid, 1case presented corneal exposure due tohyperthyroidism. Clinical features: All the patients presented foreignbody sensation, photophobia, pain, blurring of vision. Conjunctivaland circumcorneal injection was common. It also manifested yellowor gray stromal infiltration or defection, even corneal perforation andendophthalmitis. 40 cases had hypopyon, 39 cases had cornealperforation, 42 cases had secondary glaucoma, 31cases had cornealneovascularization, 13 cases had iris neovascularization.For fungal and bacterial keratitis, we clean the necrosis anddischarge before droping the antibiotic and anti-fungal medicine. Forviral keratitis, we used anti-viral medicine locally and systemically.All the patients took vitamine , 1% atropin ointment and thenon-steroid anti-inflammatory drugs orally .56 cases were appliedTimolol 0.25% eye drops and Diamox 0.25 orally for secondaryglaucoma or to avoid perforation. Mannitol 20% was appliedsystemically when necessary. Hot compress, ultraviolet ray andautologous serum were also important therapy methods.40 cases undertook keratoplasty. 1. Keratoplasty includedpenetrating keratoplasty (PKP)and lamellar keratoplasty(LKP).Donator material:37cases's grafts are from total eyeball, and havebeen conserved at 4℃ wet situation before transplanted in 12hours.The other 3 cases use the conserved lamellar grafts. Indication :Lesion localized under effective medication;non-operative therapyfailed, to rebuild the integrity of the eye ball or to enhance the visionability, we may chose PKP to realize it. If the total corneaunavailable or the infective part can be cleaned by excising lamellarcornea,we can choose the stored lamellar graft to perform LKP. 11eyes undertook conjunctival flap covering, If the perforation is veryserious and some content infected or for economic reasons ,we haveto try the conjunctival flap covering. The aim of the 3 kinds ofoperation is to save the infected eye or to enhance the vision ability.The operation course is almost the same as the normal ones.Postoperative treatment: without infection recurrent, anti-infectivemedicines should be used for 2weeks, and hormone can be used at 1weeks after operation. For those which drugs can not control theintraocular pressure, operation should be performed in time . 11 eyesundertook trabeculectomy. 16 eyes undertook enucleation. Thesepatients's infection were too serious to repair or for economicreasons.Result:① the keratoplasty group: all the 40 eyes were healed,and 18 cornea graft recovered transparent. ②the conjunctival flapcovering group:8 eyes of the 11 ones were healed, the other 3 failed.③the secondary glaucoma group:7 eyes of the 11 ones were healed.④the 16 eyes of enucleation were deformed healed.Conclusion: The severe infected corneal ulcer is harmful to thevision ability or the integrity of the eye and difficult to cure. If wecan perform the keratoplasty in time, it may save the eyeball andenhance the vision ability. Keratoplasty is the most effective methodto cure the severe infected corneal ulcer. And conjunctival flapcovering is also effective. For secondary glaucoma which drugcann't control, operation is necessary and can accelerate thecolalescence.