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Published on: October 21, 2022
[Treatment of fungal keratitis with partial lamellar keratoplasty]
Weiyun Shi1, Shaowei Li, Lixin Xie
1Shandong Eye Institute & Hospital, Qingdao 266071 China.
Objective:
To study the indication and clinical effect of treatment of fungal keratitis with partial lamellar keratoplasty (LKP).
Methods:
Sixty-eight cases of fungal keratitis who could not be controlled by routine antifungal medicine were treated with partial LKP with the cornea donors cryopreserved in glycerin. All patients were followed up for 6 months to 3 years after surgery. The ratio of transparent grafts and surgical complications were recorded. The disease corneal sample was divided into 2 equal parts, one for fungal culture and the other for histopathologic examination.
Results:
Sixty-four cases (94%) resulted in successful resolution of fungal infection. The corrected visual acuities were 0.2 approximately 1.0; 4 cases (6%) recurred; positive fungal culture were found in 59 cases, and were identified as Fusarium in 41, Aspergillus in 8, Candida in 4, Penicillium in 2 and other Hyphomycetes in 4 cases. Hyphae in histologic sections of corneal buttons were detected in 61 cases. In most cases hyphae could not be found in the deeper layer of the sections except the 4 cases with recurrence.
Conclusions:
Partial LKP is one of the effective operations that can succeed curing fungal infection which can not be controlled by antifungal medicines. It is effective for fungal keratitis whose infected lesion lies in the superficial or middle layer, especially when the corneal ulcer is widespread or not at the central area.
Insights
Partial lamellar keratoplasty (LKP) effectively treats fungal keratitis unresponsive to antifungal medicine. This surgical approach offers a high success rate for fungal eye infections, improving vision and preventing recurrence.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Surgical Innovation
Context:
- Fungal keratitis presents a significant challenge in ophthalmology, often proving resistant to conventional antifungal therapies.
- The need for alternative treatment strategies is critical to prevent vision loss and manage complex cases of fungal eye infections.
Purpose:
- To evaluate the clinical efficacy and indications of partial lamellar keratoplasty (LKP) for fungal keratitis.
- To assess the outcomes of LKP in patients whose fungal infections were refractory to standard antifungal treatments.
Summary:
- Sixty-eight patients with fungal keratitis resistant to antifungal medicine underwent partial LKP using glycerin-preserved donor corneas.
- The study reported a 94% success rate in resolving fungal infections, with corrected visual acuities ranging from 0.2 to 1.0.
- Fungal cultures identified Fusarium, Aspergillus, and Candida as common causative agents. Histopathology confirmed fungal presence in corneal buttons, with deeper invasion noted in recurrent cases.
Impact:
- Partial LKP emerges as a highly effective surgical intervention for fungal keratitis, particularly for superficial or mid-stromal infections.
- This procedure offers a viable solution for widespread or centrally located corneal ulcers that do not respond to medical management.
- Successful LKP can restore vision and prevent the progression of sight-threatening fungal eye infections.
