Multimodal Treatment for Fungal Keratitis

Purpose: The feasibility of standardized treatment for fungal keratitis was explored through the analysis of results. Methods: The medical records of 508 hospitalized patients with fungal keratitis in Qingdao eye hospital of Shandong province eye institute from January 2008 to December 2012 were analyzed in this retrospective study. Results: Among total 508 cases (all simple eye), 21 cases (4.1%) were cured with anti-fungal drugs, 150 cases (29.5%) by debridement, 153 cases (30.1%) through lamellar Keratoplasty (LK) treatment and 162 cases (31.9%) through penetrating keratoplasty (PK) treatment. Only 4.8% patients who had ulcer infiltration depths larger than 1/2 of corneal thickness were cured by drugs or corneal ulcer debridement while the percentages of patients applied with LK and PK who had ulcer infiltration depths larger than 1/2 of corneal thickness were 91.2% and 100% relatively. Corneal ulcer diameter > 6 mm, ulcer infiltration depth > 1⁄2 of corneal thickness, and the combination of high intraocular pressure were very important influencing factors required for corneal transplantation. Conclusions: Corneal ulcer debridement could be used as an effective scheme of early stage treatment when the ulcer infiltration depth is less than 1⁄2 of corneal thickness. LK intervention should be firmly performed when deep stromal lesions have not affected Descemet’s membrane. PK could be the last defense line for the treatment of corneal fungal infection.