The Analysis Of Efficacy Of Drug And Surgery For Treatment Of Fungal Corneal Ulcer

Object To discuss the clinical features and treatments between drug and surgery of fungal corneal ulcer which caused by different fungus groups. and provide assistance to clinical treatment.Method We choosed 125 cases diagnosed Fungal corneal ulcer which had been treated in our hospital from January 2001 to December 2006. 69 cases were males, and 56 cases females . The youngest patient was 19 years old while the oldest was 74 years old, the average was 42 years old. farmers were 49 cases, the others were 19 cases . Cause of disease: 89 cases had plant traumatic history, 32 cases were taken out of the corneal foreign body , 27 cases local long-term use of antivirus drug or glucocorticoid , 45 cases have no obvious reason .The hypha which was scraped from edge or bottom of ulcer under the sterile operation and partial superficial anaesthesia was spreaded on clean slides and tested under microscope after smeared by 10% potassium hydroxid(e10%KOH). If the hyphae and thallospore were found, cornea scraping would been done to make fungus cultivation in potatodcxtrosc agar and strain idenfication . According to different strains, the cases of fungal corneal ulcer were divided into two types: hyphomycetic corneal ulcer in 93 eyes and candida corneal ulcer in 32 eyes. The clinical features and therapeutic effects of the two types were observed and compared。76 cases drug Treatment group were divided into two groups which fluconazol 0.5% eye drops were given once per hour , these were managed with fluconazol 0.2% systemically and subconjunctival injection, and natamycin 5% and fluconazol 0.5% eye drops were given once per hour , change the frequency according to the conditions .49 cases surgical operation group which were treated differently by cleaning the center of the cornea ,removing the center of the cornea ,aspirating the pus from anterior chamber and anterior reconstructive . the two groups were treated with the systemic application of the anti-fungi medicine: itraconazole capsule took orally 200 mg everyday,and Comparison two group for treatment which efficacy would been better .Result①125 cases were fungus cultivation masculine, 93 hyphomycete and 32 candida. Among 93 hyphomycete there were 35 fusarium。②Fungal corneal ulcer caused by different strains have the different clinical features .The hyphomycetic corneal ulcer :the border of corneal infiltration was not clear with feather edges , and had a tendency to penetrate into the deep stroma of corneal There were endothelial plaques , hypopyon and bad therapeutic effects. candida corneal ulcer :the fungus seldom expanded into the deep corneal layers and infiltrated into the inner eye. Its therapeutic effects were better. The border of candida corneal ulcer was characterized with limitations, and was clear .③for constituent ratio of patient's condition of different degree in hyphomycetic and candida keratitis group, there was no significance in difference .④The effective rate of fluconazol group was 52.6%, The effective rate of natamycin and fluconazol group was 76.7%, Comparison effective rate for two group for hyphomycetic keratitis treatment, there was significance in difference. The total effective rate in no-surgical operation treatment group and surgical operation treatment group was 65.5% and 89.2%, there was significance in difference.Conclusion①The clinical features of the two types are different. The clinical features caused by different or the same pathogenic fungi show great variations.②Broad spectrum antifungal agents, the polyene and triazole, are efficacious drug to Fungal corneal ulcer, besides The curative effect is conspicuous to the low-grade cases. The effect of the natamycin and fluconazole combination is more remarkable.③The antifungal agent is the first choice for fungal corneal ulcer once the diagnosis of fungal infection is made .The operation should be performed when sustained medication is invalid ,the area of ulcer enlarges ,and the ulcer has the tendency of perforation . Although there is no perforation, the keratoplasty should be done according to the degree of ulcer encroachment in the cases that the antifungal drug is invalid or the area of ulcer is comparatively large.