穿透性角膜移植治疗重症真菌性角膜溃疡效果观察

目的探讨穿透性角膜移植治疗重症真菌性角膜溃疡的临床效果。方法对重症真菌性角膜溃疡10例(10眼)行穿透性角膜移植术,随访3~6月。结果术后10眼感染全部得到控制,8眼植片透明,1眼行二次穿透性角膜移植,术后角膜透明。术后视力均比术前提高。结论穿透性角膜移植治疗真菌性角膜溃疡可有效地控制感染,改善视功能,效果较好。     

干燥保存角膜穿透性移植治疗真菌性角膜溃疡

目的：观察以干燥保存角膜片进行穿透性角膜移植术治疗严重的真菌性角膜溃疡的疗效。方法：采用无水甘油保存的角膜片进行穿透性角膜移植68例,术后随访6月－5年。结果：68例中,67例经手术治疗后感染控制,植片存活。其中4例术后复发,经药物和再手术治愈。术后主要并发症有排异反应、继发性青光眼、大泡性角膜病变等。结论：对药物治疗无效的严重的真菌性角膜溃疡,穿透性角膜移植可有效去除病灶,控制感染,重建眼球,为二期光学角膜移植奠定基础。     

治疗性光学角膜切削术治疗真菌性角膜炎

近年真菌性角膜炎的发病率上升。许多真菌性角膜炎单纯用药物治疗效果有限。在抗真菌治疗的同时，给予非药物性补充治疗有助于改善预后。手术治疗包括清创、穿透性角膜移植、板层角膜移植术等，常使创面扩大，创面不平，遗留瘢痕。准分子激光治疗性光学角膜切削术（PTK）可以去除角膜表面的病变组织，并使角膜表面变平整，     

角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎

目的:总结角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎的效果。方法:收集2010-09/2011-09在我院就诊的真菌性角膜炎患者30例,对患者进行常规角膜刮片检查,并对全部患者施行角膜溃疡清创术,根据角膜炎的严重程度联合给予氟康唑或那他霉素眼水点眼治疗,清创术治疗无效者采用自体结膜覆盖术及板层角膜移植术治疗,随访观察治疗效果。结果:角膜刮片阳性结果 27例,阳性率90%,2例于外院行共聚焦显微镜检查菌丝阳性;1例为明确植物外伤史的8岁儿童,不能配合真菌检查。轻度角膜炎6例,施行角膜溃疡清创术联合氟康唑眼水点眼治疗全部痊愈,病程2～3wk;中度度角膜炎17例,行角膜溃疡清创术联合那他霉素眼水点眼治疗痊愈12例,病程4～8wk;重度角膜炎7例,行角膜溃疡清创术联合那他霉素眼水点眼治疗痊愈3例,病程8～10wk。角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎有效率70%。结论:角膜溃疡清创术联合抗真菌药物治疗真菌性角膜炎操作简单,是一种经济、有效、可行的治疗方式。     

真菌性角膜溃疡的手术治疗

目的：评价板层角膜移植和穿透性角膜移植对真菌性角膜溃疡的治疗效果。方法：以无水甘油保存的角膜片或新鲜角膜材料,根据真菌性角膜溃疡的面积和深度的不同行板层角膜移植术和穿透性角膜移植术,板层移植术中手５％的碘酊烧灼植床表面,穿透性角膜移植术中应同时清除虹膜表面渗出物并以林格氏液冲洗。结果：３１例真菌性角膜溃疡的患者行板层或穿透性角膜移植术,２９例一次手术痊愈并获得良好视功能。２例复发,二次穿透性角膜移     

用婴儿供体角膜行穿透性角膜移植治疗真菌性角膜溃疡

目的 观察用婴幼儿供体角膜行穿透性角膜治疗真菌性角膜溃疡的效果。方法 采用３岁以下（平均１．６岁）婴幼儿供体角膜行穿透性角膜移植治疗真菌性角膜溃疡２６例２６眼。结果 手术治愈率达９２．３％,植片透明率达８３．３％,视力获不同程度提高者７９．２％。结论 婴幼儿供体角膜具有材料易得及内皮愈合储备能力高的优点,穿透性角膜移植治疗真菌性角膜泪疡可以控制感染、缩短病程、提高视力及保全眼球。     

镰刀菌族角膜溃疡的治疗

真菌性角膜溃疡是一种致盲率很高的感染性角膜疾病,多发生于农业劳动者。自1985年至1990年,我们对27例病情严重的镰刀菌族角膜溃疡患者进行治疗观察。其中18例采用抗真菌药物治疗获得痊愈;3例药物治疗无效,溃疡面积达8mm~2;均伴有前房积液,行治疗性穿透性角膜移植;6例因大面积角膜穿孔眼内容脱出,行眼球摘除或眼内容剜出术。现报告如下:一般资料一、病例诊断:全部根据实验室检查。包括溃疡刮片,真菌培养或病理切片组织检查找到菌丝。二、病例情况:男性20例;女性7例,最大年龄62岁,最小年龄10岁,平均年龄38.3岁。来院前病程:3天以内1例;10～15     

重症真菌性角膜炎患者的临床特征分析

目的:探讨重症真菌性角膜炎病因、人群特征及临床特点。方法:搜集2008-01/2013-11就诊于我院眼科的233例233眼重症真菌性角膜炎患者的临床资料,回顾性分析其病因、人群特征、临床特点等情况。结果:重症真菌性角膜炎233例患者中,男153例(65.7%),男女比例约为1.9∶1;年龄分布中,中老年龄段人数居多,平均年龄52.7±11.3岁;居住地多为农村(78.1%);并且其职业以农民为主(66.1%),发病患者文化程度普遍较低(59.7%);重症患者中,188例(80.7%)患者具有明确的眼部外伤史,以植物性外伤为主(60.9%)。主要致病菌属为镰刀菌属,为90例(57.3%),其次为曲霉菌属47例(29.9%);治疗中手术率为87.9%。其中多数行穿透性角膜移植术,为83例(52.9%),在镰刀菌及曲霉菌感染的重症角膜炎患者中,行穿透性角膜移植术者比例较高,为58.4%(80/137);行眼内容剜除术或眼球摘除术的重症患者中,68.4%(13/19)的患者为镰刀菌属感染。结论:我院重症真菌性角膜炎患者多为农村居住的中老年男性农民,可能与其经济条件及诊疗意识差有关。其主要致病菌为镰刀菌及曲霉菌属,穿透性角膜移植手术为主要治疗手段,且预后差的重症患者多为镰刀菌感染。     

穿透性角膜移植术后并发真菌性角膜溃疡的护理

真菌性角膜溃疡是一种致盲率很高的感染性眼病。此病占感染性角膜疾病的1．9％。由于本病不易诊断且无特效的局部抗真菌药物，治疗较困难，往往使病人失明或角膜溃疡穿孔以致摘除眼球。而穿透性角膜移植术后并发角膜植片真菌感染更为凶险。现将护理体会总结如下。     

真菌性角膜炎的手术治疗

真菌性角膜炎是一种致盲率非常高的感染性角膜疾病。近年来 ,随着抗生素和糖皮质激素的广泛使用及角膜接触镜的出现 ,真菌性角膜炎的患病率逐年上升〔1〕。我国真菌性角膜感染占化脓性角膜感染的4 6 7% 〔2〕,谢立信统计占角膜移植术原因的33 2 % 〔3〕。至少有 70种真菌与真菌性角膜炎有关〔4〕。病因学可分为内因性和外因性两种 ,前者多与机体免疫机能下降有关 ,常为白色念珠球菌所致 ;后者多与角膜外伤有关 ,常为曲霉菌和镰刀菌所致〔5〕。在欧美国家中 ,内因者多见 ,在我国 ,则以外因者多见 ,多见于植物刮伤后。随着新型抗真菌药物的发…     

Fungal keratitis in a soft contact lens wearer.

PURPOSE: To describe a case of fungal keratitis in a soft contact lens wearer. METHODS AND RESULTS: A 57 year old female, compliant, frequent replacement soft contact lens wearer, with a possible prior history of herpes simplex keratitis, presented with pain and injection of her left eye of four weeks duration. Gram stain of a corneal ulcer of the left eye revealed fungal organisms and cultures grew Fusarium solani. The infiltrate responded to topical and systemic antifungal agents, but a corneal perforation developed which required a therapeutic penetrating keratoplasty. CONCLUSIONS: Fungal infections are a cause of corneal ulcers in contact lens wearers. Despite the use of topical and systemic antifungal agents, fungal ulcers frequently require surgical intervention.     

Therapeutic contact lens-related bilateral fungal keratitis.

PURPOSE: To describe a rare case of bilateral Candida keratitis after contact lens use following bilateral penetrating keratoplasty (PK). METHODS: A 40-year-old female with a clinical diagnosis of Sj?gren's syndrome was being followed for corneal thinning in both eyes. She suffered a spontaneous bilateral perforation and underwent penetrating keratoplasty. Therapeutic contact lenses were prescribed for both eyes owing to persistent epithelial defects. Two months later, a biomicroscopic examination revealed corneal infiltrates. RESULTS: A corneal tissue sample, saline, and contact lens cultures were all positive for Candida albicans. Topical and systemic antifungal therapy successfully cleared the infection in the right eye; however, the left eye underwent another corneal graft surgery. CONCLUSIONS: Infectious fungal keratitis may be a complication of wearing therapeutic contact lenses after PK, in a patient with Sj?gren's syndrome. The pre-existing eye disease is an important associated factor in cases of yeast infection; therefore, adequate care of these patients and careful follow-up after PK are indicated as measures to prevent early infections.     

Fungal keratitis secondary to Scedosporium apiospermum infection and successful treatment with surgical and medical intervention

To report a rare case of severe fungal keratitis caused by Scedosporium apiospermum, which was treated with a penetrating tectonic keratoplasty and aggressive medical treatment. A 62-year-old woman with a history of soil contamination of the right eye while planting vegetables presented with a severe corneal abscess and ocular pain. The patient received medical treatment and underwent tectonic keratoplasty. Both corneal scrapings and the corneal button were evaluated microscopically. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. Microbiological examinations showed S. apiospermum. The isolate was sensitive to amphoterycine B, caspofungin, voriconazole, and resistant to fluconazole. No clinical improvement was achieved with topical voriconazole, vancomycin, ceftazidime, and systemic voriconazole. A penetrating tectonic keratoplasty and lensectomy with continuation of anti-fungal therapy achieved satisfactory results. A fungal etiology should be suspected in a progressive and untreatable corneal abscess. Microbiological investigation is very important in early diagnosis. Despite early diagnosis and aggressive treatment, in selected cases removing the infected tissue surgically is vital in preserving the ocular globe and vision.     

Severe keratomycosis secondary to Scedosporium apiospermum

PURPOSE: To report an unusual case of severe keratomycosis caused by Scedosporium apiospermum without any known previous ocular injury, that resulted in a corneal perforation, which was treated with an emergency penetrating tectonic keratoplasty and later with phacoemulsification and astigmatic keratotomy to restore good visual function. METHODS: A 45-year-old woman with a history of multiple sclerosis presented with a severe and refractory corneal abscess in her right eye without any known prior injury. Corneal scrapings were obtained and stained for microscopic evaluation. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. RESULTS: Microbiologic examination of the corneal scraping showed Scedosporium apiospermum micelle. The fungal culture was sensitive to miconazole, itraconazole and voriconazole. Partial clinical improvement was achieved with hourly topical natamycin, amphotericin B, and systemic itraconazole application, although in vitro sensitivity tests showed resistance to the topical antifungal agents used. A corneal paracentral perforation occurred despite aggressive treatment. An emergency eccentric penetrating keratoplasty was performed with satisfactory results. Subsequent phacoemulsification and astigmatic keratotomy restored a good visual function. CONCLUSION: A fungal etiology should be suspected in a progressive and refractory corneal abscess. This report highlights the utility of microbiologic investigation to perform an early and accurate diagnosis. Aggressive medical treatment and even therapeutic penetrating keratoplasty to remove infected tissue could result in the maintenance of useful visual function. In view of the poor prognosis of this specific fungus, a closer observation and early keratoplasty might be required to preserve the ocular globe.     

Painless acanthamoeba keratitis

BACKGROUND: Acanthamoeba keratitis is a severe, painful corneal infection found in contact lens wearers. The entity can easily be confused with herpetic or fungal keratitis, especially if no ocular pain is reported. HISTORY AND SIGNS: A 32-year old myopic female presented a unilateral keratitis of unknown etiology since 3 weeks. Administration of topical antiviral substances and corticosteroids led only to temporary improvement of the condition. The patient complained of photophobia but not of ocular pain.The affected eye showed corneal edema, central stromal thickening, descemet's striae as well as fibrin deposits on the corneal endothelium and in the anterior chamber. DIAGNOSIS: An aqueous specimen was negative for a viral infection. A culture for bacteria was negative. Staphylococci were cultured from corneal scrapings and Enterococci from the contact lens solution. Another corneal scraping revealed Acanthamoeba class II (6 weeks after the onset of symptoms). CLINICAL COURSE: Under treatment with propamidine, polymyxin b, neomycin, gramicidin and polyhexidine (topical) as well as fluconazole/ketoconazole (systemic) the diameter of the annular infiltrate, which had developed decreased, but the infiltrate persisted. In the further course, the infiltrate persisted while the amount of fibrin in the anterior chamber increased. Penetrating keratoplasty was performed. Histologic examination of the host corneal tissue revealed massive infiltration with Acanthamoeba. CONCLUSIONS: Severe pain and history of wearing contact lenses are features suggestive of Acanthamoeba keratitis. The patient presented here had a history of contact lens wear, but no ocular pain was reported. The characteristic annular infiltrate had a late onset. Bacterial superinfection could not be ruled out. Therapeutic penetrating keratoplasty had to be performed as the condition deteriorated inspite of intensive chemotherapy. With penetrating keratoplasty a good visual acuity could be regained.     

Bilateral Acanthamoeba keratitis with late recurrence of the infection in a corneal graft: a case report

PURPOSE: To report a case of bilateral Acanthamoeba keratitis with late, atypical recurrence after penetrating keratoplasty a chaud. METHODS: A 23-year-old contact lens wearer was treated for bilateral Acanthamoeba keratitis and underwent penetrating keratoplasty in the right eye for descemetocele with impending risk of perforation. The postoperative course was uneventful and topical steroids were combined with neomycin and propamidine. Two months after the operation in the right eye the patient presented with active infection in the left eye. One month later recurrence appeared in the right eye, as a central corneal infiltrate in the graft. RESULTS: Recurrences in both eyes were successfully treated with a combination of hexamidine and neomycin, and with polyhexamethylene biguanide respectively. The right eye was regrafted three months after the recurrence and penetrating keratoplasty was done two years later in the left eye. Both grafts were successful and remained clear. There has been no further recurrence in the long-term follow-up. CONCLUSIONS: Recurrence of Acanthamoeba keratitis after penetrating keratoplasty a chaud may occur even several months after the operation and the manifestation may be atypical. Current antiamoebal therapy was effective and regrafting in the quiet eye was successful.     

Purulent corneal melting secondary to multidrug-resistant Fusarium oxysporum aggravated by topical corticosteroid therapy

Keratomycosis is a rare sight-threatening infection of the cornea. Predisposing factors in its pathogenesis are corneal trauma, mostly of plant origin, contact lenses, and overuse of topical corticosteroids. We report a case of a 44-year-old woman, with no ophthalmologic history, who developed severe keratitis 7 days after beginning topical therapy with a corticosteroid and antibiotic. Microbiological analysis revealed Fusarium oxysporum keratitis. Despite aggressive antifungal therapy with Voriconazole and Amphotericin B, she required a penetrating keratoplasty for impending corneal perforation. A second keratoplasty was performed because of corneal-transplant rejection after 6 months. There was no recurrence of Fusarium infection.     

Clinical experience with N-butyl cyanoacrylate tissue adhesive in fungal keratitis

PURPOSE: To evaluate the role of tissue adhesive in the management of corneal thinning or perforation associated with active fungal keratitis. DESIGN: Retrospective noncomparative interventional case series. METHODS: Seventy-three eyes of 73 patients with microbiologically proven keratomycosis associated with thinning or perforation participated in the study. N-Butyl cyanoacrylate tissue adhesive (medical grade) and bandage contact lens were applied in addition to topical and systemic antifungal therapy. Our outcome measures included resolution of the infiltrate and preservation of the structural integrity of the globe. RESULTS: Outcome data were available for 66 eyes. The infiltrate resolved with scar formation in 42 (63.6%) eyes. In an additional eight (12.1%) eyes, tissue adhesive maintained the structural integrity of the globe while the patients awaited penetrating keratoplasty. Sixteen (24.2%) eyes showed progressive worsening or persistence of the infiltrate after application of tissue adhesive. Twenty-five (37.8%) eyes required multiple applications of tissue adhesive. The outcome was better in cases where the infiltrate measured less than 30 mm2 at the time of presentation and application of tissue adhesive (P < 0.01). CONCLUSION: In view of the poor outcome of penetrating keratoplasty in active fungal keratitis, N-butyl cyanoacrylate tissue adhesive is a useful modality for the management of progressive thinning or perforation associated with active fungal keratitis. However, close observation is mandatory to assess the progression of disease.     

Fungal invasion of a therapeutic soft contact lens and cornea.

A fungal corneal infection occurred in a 66-year-old man who wore a therapeutic soft contact lens for 12 months during treatment for a metaherpetic corneal epithelial erosion. The infection was documented by finding positive cultures from both the contact lens and the cornea, and histologic evidence of fungal infiltration of the therapeutic soft lens. The fungus was identified as Cephalosporium acremonium. Pathogenic fungal invasion of soft lenses is unusual. Corneal infections associated with such conditions are rare. This case demonstrates histologically, a pathogenic fungal corneal infection arising from therapeutic contact lens wear. Factors that may influence soft lens infiltration by fungi are: (1) enzymatic activity produced by the fungus, and (2) lens material properties which provide a matrix and a nutrient source for fungal growth. Continuous-wear soft contact lens treatment with topical steroid and prophylactic antibiotics used in combination in an already compromised cornea were thought to be responsible in an already compromised cornea were thought to be responsible for this complication. A therapeutic penetrating keratoplasty was performed when the infection and its accompanying inflammation became clinically unresponsive to multifold therapy, and a corneal perforation was imminent. The eye was salvaged with a resulting clear graft and stable intraocular pressures.     

Successful treatment of Paecilomyces lilacinus keratitis in a patient with a history of herpes simplex virus keratitis

PURPOSE: To report a case of Paecilomyces lilacinus keratitis, initially misdiagnosed as Penicillium sp., in a patient with a long-standing history of herpes simplex virus (HSV) keratitis. METHODS: A retrospective case report. RESULTS: A 62-year-old man developed P. lilacinus keratitis. He was treated with topical steroids for immune stromal keratitis secondary to HSV before developing the fungal keratitis. Initial corneal cultures were positive for Penicillium sp., but subsequent cultures identified P. lilacinus to be the causative organism. The patient later developed an anterior chamber abscess. Three penetrating keratoplasties, as well as intravitreal injection of amphothericin B, topical miconazole, subconjunctival miconazole, and systemic fluconazole, were required to eradicate the infection. CONCLUSION: To our knowledge, this is a first report of P. lilacinus keratitis in a patient with a previous history of HSV keratitis. The causative organism was initially reported as Penicillium sp. on 2 occasions, before the correct diagnosis was made. Paecilomyces keratitis progressed to an anterior chamber abscess in this eye. Aggressive treatment, including a therapeutic penetrating keratoplasty, intravitreal amphothericin B injection, topical miconazole, and systemic fluconazole can be successful in eradicating this extremely difficult-to-treat infection.