The Operation Of The Conjunctival Flap Totally Covering Cornea In The Treatment Of The Mod Erate To Severe Fungal Keratitis

objective: We investigate the efficacy of the operation of the conjunctival flap totally covering cornea in the treatment on the moderate to severe fungal keratitis through making rabbits models artificially.Methods:using 37 adult Japanese white rabbits weight of 2-3kg but not limited the gender,We divided these rabbits into model group(group a,n=35)and model control group(group b,n=2)according to complete random design.Adjusting the concentration of the aspergillus flavus to 108 colony forming units(colony forming,unit,CUF)/ml:A unit of Maxwell's turbidity unit(1 Mcfarland)equal to 3*108 CUF/ml,which is diluted 3times to 108CUF/ml.The preliminary experiment is performed by corneal interlaminar injection,while the corneal interlamellar injection combined with corneal scarification is used in the formal experiment;Using BD Disposable sterilized insulin syringe gives the corneal stroma 1 unit Aspergillus flavus which's concentration is 1*108CUF/ml at the center of the pupil at 10 o'clock.and then scratch the epithelial tissue of the right cornea to 3-4mm with a sterile blade.The needle is used to scratch cross shape on the corneal surface to the superficial stroma,We drip the aspergillus flavus fluid onto the corneal surface and inject 10 thousand units of gentamicin(0.5ml)under subconjunctival.The control group(group b)is used the right eye as model control eye,except to injecting the same equivalence saline and without scratching fungal colonies,the rest of the process was the same as the experimental group.We check if the mold is successful using the slit lamp microscope?10%KOH smear?Ag NOR staining and fungal culture after 48 hours.Preparation 2% voriconazole liquid,Selection the standard rabbits model,They are equally divided into three groups: A,B and C,each group has 11 marked rabbits,in addition to group D(2 rabbits).group A is given0.5ml voriconazole solution under subconjunctival,group B is given The operation of the conjunctival flap totally covering cornea,group C is given 0.5ml voriconazole solution under subconjunctival and the conjunctival flap totally corneal coverage.Experimental control group(group D)is given equal amount of saline intervention.Dosing rate: 7days ago,1 times / day,7 days later,1 /2 days,14 days later,1 /3days.After given intervention,the healing of corneal ulcer is observed under slit lamp microscope,the healing and recurrence of the corneal ulcer are observed for 3 months.the quantitative data is demonstrated with The mean±the standard deviation,statistical analysis is analyzed by SPSS 17 statistical software,quantitative data use a single sample t test,ANOVA analysis of variance and the SNK to analyze between groups,qualitative data were compared by chi square test,P < 0.05 was statistically significant difference.Results:The preliminary experiment's final results of conjunctival flap and corneal coverage are conjunctival flap loosening,suture suture?conjunctival flap defect?smoothy corneal epithelium and corneal edema.The results of the corneal interlaminar injection united corneal scarification to establish the rabbits fungal keratitis is as follows.group A:2 of the rabbits are mild fungal keratitis,15 of them are moderate fungal keratitis and 18 belonged to severe fungal keratitis.group B:free from infection.2 rabbits unsuitable for this test are e xcluded,The success rate of molding is 94.29%.After three different intervention methods for fungal keratitis:comparison group A(voriconazole)?group B(The operation of the conjunctival flap totally covering cornea)and group C(voriconazole and The operation of the conjunctival flap totally covering cornea),The healing time of the group C is the shortest and considered Statistically significant(P<0.05),the effective power of group B is higher than group A and The difference is statistically significant.Conclusion: Conjunctival flap corneal coverage is not suitable for fungal keratitis without superficial corneal injury.corneal interlaminar injection united corneal scarification can successfully establish the rabbits fungal keratitis,This method has a high success rate of modeling.the three different interventions are used,The total effective rate of the voriconazole and The operation of the conjunctival flap totally covering cornea is the highest,and The healing time of it is the shortest,the voriconazole merelyis obviously more effective than the operation of the conjunctival flap totally covering cornea.