The Analysis Of Diagnosisand Treatment Of Fungal Corneal Ulcer

ObjectivesThis work was carried out to summarize the causes and risk factors of fungal corneal ulcer by reviewing the cases in our hospital. The corneal smear, smear, confocal microscopy, fungal culture and pathological were compared according to their efficacy. The effect of different drugs and drug-surgery therapeutics were analyzed. The results of this work provided favorable information for diagnosis and treatment of fungal corneal ulcer.MethodsUsing retrospective analysis method, we checked133cases of in-hospital patients from June2011to May2013who were diagnosed as fungal corneal ulcer. Patients were classified according to the severity of fungal infection. The causes and risk factors were summarized and analyzed according to the record. The diagnostic evidences were sorted out and analyzed for the relationship with experimental results. Therapeutic effect of treatment by different drugs and drug-surgery combinations were compared. These clinical data were statistically analyzed using SPSS software.Results1.Among the133eyes in133cases, farmers accounted for82.71%. Most of the patients were41-60years old. was accounting for66.17%of the total. Farmer work caused infections in56cases, which was42.11%of the total.2. In laboratory tests, the positive rate of confocal microscopy was the highest (93.98%). KOH microscopic examination was positive in93.23%cases. Pathology analysis was positive for85.59%cases. In constract, the positive rate was only78.2%for fungal culture.76cases were infected by Fusarium in the104positive cases. For umphotericin B,20cases were sensitive and46cases were resistant.36cases were sensitive to itraconazole, but38cases were resistant.14cases were sensitive to fluconazole. and33cases were resistant to fluconazole.For voriconazole.74cases were sensitive and7cases were resistant.3.13cases of fungal corneal ulcer were cured by medication in133cases.1case with mild fungal corneal ulcers was cured by fluconazole eye drops combined with natamycin eye drops.5cases with moderate fungal corneal ulcers were cured using fluconazole eye drops combined natamycin eye drops, and one case was effective. Among127cases with severe fungal corneal ulcer were treated by simple drug therapy.8cases were cured (6.30%),14cases were effective, and105cases were ineffective.4.115cases were treated by drug-surgery combination in133cases where it was effective for109.1moderate case was cured by drug-excision combination. In127severe cases.5cases gave up treatment and114cases were treated by drug-surgery combination.1case was treated by enucleation of eye contents, which was considered effective.8cases treated by lesion resection were all cured.2cases treated with anterior chamber wash were cured.4cases treated with conjunctival flap were all effective.20/21(95.24%) cases treated with I.KP were cured.22cases treated with DLKP were all cured (100%).51/56cases (91.07%) treated with PKP cured.Conclusions1. Plant injury is the main cause of fungal corneal ulcer and farmers accounted for the highest infection. Risk factors of fungal corneal ulcer include profession, age, self-protection awareness, and personal hygiene habits2. Confocal microscope is the quickest and the most effective method in the diagnosis of fungal corneal ulcer. Fungal culture is the most reliable approach for diagnosis of fungal corneal ulcer, which can identify fungi strains and their sensitivity to drugs. The main pathogen of fungal corneal ulcer in Shandong is Fusarium. The fungi in this article were most sensitive to voriconazole. Most of the strains were resistant to amphotericin B.3. Fluconazoleeye drops combined natamycin eye drops is effective for mild and moderate fungal corneal ulcer. Frequent administration of Voriconazole eye drops combined natamycin eye drops is effective to treat severe fungal corneal ulcer.4. For cases with severe fungal corneal ulcer, individualized treatment plan should be considered. Correct drug-surgery combination should be carefully chosen according to the basic condition of patients.