Two-step strategy—conjunctival flap covering surgery combined with secondary deep anterior lamellar keratoplasty for the treatment of high-risk fungal keratitis

AIM: To investigate whether the two-step strategy [conjunctival flap covering surgery (CFCS) combined with secondary deep anterior lamellar keratoplasty (DALK)] is effective for patients high-risk fungal keratitis (FK). METHODS: In this noncomparative, retrospective case series, 10 subjects (6 males, 4 females) a mean age of 56.5±7.1 (range 47-72)y FK undergone were included. Reported outcome measures healing corneal ulcer, recurrence FK, reject reaction, improvement in best corrected visual acuity (BCVA) and relevant complications. RESULTS: The average diameter infiltrates was 7.50±0.39 mm, ranging from 6.94 to 8.13 mm. depth 422.4±77.1 μm, 350 535 μm. thickness 597.4±117.3 458 851 Hypopyon endothelial plaques presented all patients. period between two steps 3.65±0.9 (ranging 3 5)mo. graft 7.75±0.39 At last follow-up (average 9.25±3.39, 5.5 17mo), no or rejection appeared, showed BCVA. One patient suffered liver function impairment due oral voriconazole 4wk recovered spontaneously after 1wk drug withdrawal. CONCLUSION: safe treatment by transforming intentional therapeutic penetrating during acute infection later optical DALK. It practical strategy, especially areas lacking fresh donor corneas eye bank services.