The Analysis Of Diagnosis And Clinical Curative Effect Of126Cases Of Fungal Corneal Ulcer

Objective: To evaluate the diagnostic method of fungal corneal ulcer andanalyse the clinical treatment effects of drugs and surgery.Method: Collect the base data of126eyes of126patients which were admittedby the China-Japen Union Hospital from January2010to December2012. Allthe patients were clarified a diagnosis by laboratory examination. The patientswere classified by the degrees of corneal ulcer. The clinical efficacy of differentdegrees of corneal ulcer were analysed after drug therapy or surgery.Result:1)86of126(68.25%)eyes were positive by fungal culture test,77of126(61.11%) eyes were positive by KOH smear test.25of126eyes wereexamined by confocal microscope test, and20(80.00%) eyes were positive. Thepositive rates were compared within three test method. The result showed thatthere was no significant difference between confocal microscope test andfungal culture test(χ~2=1.376,P>0.05). The difference was observed in confocalmicroscope test vs KOH smear test group(χ~2=0.78,P<0.05)and fungal culturetest vs KOH smear test group(χ~2=11.007,P<0.05).2) Treatment effect:32eyesof mild corneal ulcer which were treated by drugs were all cured. The totaleffective rate was100%.12of44of moderate corneal ulcer were noneffective,and the total effective rate was72.73%. During the moderate corneal ulcergroup,11of33eyes which were treated by drugs were noneffective, and1of11eyes which were treated by amniotic membrane transplantation wasnoneffective.15of50eyes of severe corneal ulcer were noneffective, and thetotal effective rate was70.00%. During this group,12of14eyes which weretreated by drugs were noneffective,3of11eyes which were treated byconjunctival flap covering surgery were noneffective. And11eyes which were treated by penetrating keratoplasty were all cured. The results showed asignificant difference in moderate corneal ulcer between the amnioticmembrane transplantation group and the drugs group(χ~2=4.136,P<0.05). Theefficacy of amniotic membrane transplantation surgery was better than drugs.During the severe corneal ulcer group, there was a significant difference amongdrugs group, conjunctival flap covering surgery group and penetratingkeratoplasty surgery group(χ~2=27.483,P<0.05). The efficacy of conjunctivalflap covering surgery group was better than drugs group, but worse thanpenetrating keratoplasty surgery group. The results also showed that theefficacy of surgery group was much better than drugs group in both moderateand severe corneal ulcer group.Conclusion:1. The KOH smear test can be used as a initial inspectionmethod for fungal corneal ulcer. The confocal microscope test and fungalculture test can be used as a recheck method because of higher positive rate.2.The early diagnosis and treatment for fungal corneal ulcer could gain asignificant efficacy and a high cure rate.3. The efficacy of drug treatment formild fungal corneal ulcer was good.4. The efficacy of surgery combined withdrugs was better than drugs only treatment for moderate and severe fungalcorneal ulcer.