The Clinical Analysis Of Fungal Corneal Ulcerations

Object To learn the main pathogenic bacteria of mycotic cornealulcer in the JiLin province and discuss the dangerous factors ,clinicalfeatures and clinical significance during the prevention and cure offungus ophthalmocace in corneal ulcer caused by different fungusgroups. To provide assistance to clinical therapy.Method We choosed 42 patients with mycotic corneal ulcer whichhad been treated in our hospital from May 2004 to December 2005.The course of disease was 8 days to 7 months. The vision lightperception was 0.3 ,the diameter of ulcer was 2.5mm to all corneaand with or without complications such as succeeded glaucoma ,hypopyum,et ac. 22 males and 20 females . the age was 20 yearsoldto 71 years old and the average was 46 years old. All patientscame from Jilin province. The hypha which was scraped from edgeor bottom of ulcer under the sterile operation and partial superficialanaesthesia was spreaded on clean slides and tested under miroscopeafter smeared by 5%KOH. If the hyphae and thallospore werefound ,cornea scraping would been done to make fungus cultivationaand strain idenfication . Inquring the medical history in details andclassifying according to the morbility causes . All of funguscultivation masccline patients were recored in details according tostrains : the degree of pathological changes in the preliminarydiagnosis, the development of disease and prognosis .Result 1. 41 cases was fungus cultivation masccline. Among themthere were 21 fusarium ,7 aspergillus, 5 monilia, 1 alternariaalternata, 1 phialophora verrucosa and 3 which can not be identified .2. In this study most cases caused by fusarium and aspergillus werecoming from village . The reason almost was scuffing cornea byplants such as branch ,corn leaf during agriculture working. 52.38%fusarium and 57.14% aspergillus cornea ulcer patients were causedby scuffing of plants . 3. The patient's condition of fusarium cornealulcer was fairly heavy in the preliminary diagnosis .The seriouscases were 66.67% of all and more than the aspergillus cases. On thecontrary , the condition of monilia corneal ulcer was relativelylight ,the light and midrange cases were 60% and 40% in thepreliminary diagnosis . 4 . Mycotic corneal ulcer caused by differentstrains have the same clinical feature : hypha moss coat. Thefusarium corneal ulder in the early process would appeardistinctively plumelike edge, 15 cases of hypopyon with differentdegrees of satellite focus,immunoloop and pseudopodium. Theincidence rate of hypopyon was 57.14% in aspergillus corneal ulcerand 20% in monilia corneal ulcer . 4 cases perforated in fusariumcorneal ulcer which occupied 19.05%. The average time was 56days . 3 cases perforated in aspergillus corneal ulcer which occupied42.86%. The average time was 35 days . 5 . The total effective rateof treatment was 84.85%. The effective rate in fusarium cornealulcer and aspergillus corneal ulcer was 80.95% and 85.71% ,therewas no significance in difference. The effective rate in moniliacorneal ulcer was 100%.Conclusion The pathogen of fungal keratitis is different as naturalconditions such as geographical environmen and climate aredifferent in each country and area . The main pathomycete of fungalcorneal ulcer is fusarium , the next is aspergillus and monilia, whichis uniform with the fact that the main pathomycete of fungal keratitisin other areas of our country is Fusarium. 2 . The pathogeny isdifferent in each strain . Filamentous fungus and Aspergillus cornealulcer are almost caused by plants scuffing . Most patients offusarium and aspergillus corneal ulcer are farmers . The pathogeny isalmost that cornea is scuffed by plants during agricultural working .But the pathogeny is not found yet in most patients of moniliacorneal ulcer after detailed medical history inquiring . The course offusarium corneal ulcer is short ,the development is very quick , thepathological changes can reach deep layer of matrix ,also canprotrude into the surface of cornea ,the edge is not clear which looksas plume . In preliminary diagnosis the patient's condition is seriousand the range is broad . The cornea infected by fungus can be brokenin weeks . The condition in monilia corneal ulcer is light .Thefusarium corneal ulcer is generally thought as the most serious kindin the mycotic corneal ulcer , and fusarium is the main pathogenicfungus in the fungal keratitis in our country . 4 . The antifungal agentis the first choice for fungal keratitis as the diagnosis of fungalinfection is made . But the therapy may be adjusted after fungalcultivation . The antifungal drugs should be choosen according tostrain .The operation should be performed when sustainedmedication is invalid ,the area of ulcer enlarge ,the ulcer has thetendency of perforation . Althought there is no perforation ,thekeratoplasty should be done according to the degree of ulcerencroachment in the cases that the antifungal drug is invalid or thearea of ulcer is comparatively large.