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Published on: September 17, 2014
Early keratectomy in the treatment of moderate Fusarium keratitis
Hsin-Chiung Lin1, Ja-Liang Lin, Dan-Tzu Lin-Tan
1Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. hclinn@adm.cgmh.org.tw
Purpose:
To evaluate the treatment outcomes and costs of early keratectomy in the management of moderate Fusarium keratitis.
Methodology/Principal Findings:
Consecutive cases of culture proven Fusarium keratitis treated at our hospital between January 2004 to December 2010 were included in this retrospective study. There were 38 cases of moderate keratitis with infiltrates between 3 to 6 mm in diameter and depth of infiltration not exceeding the inner 1/3 of the cornea. After excluding 5 patients with incomplete follow-up data, 13 patients who received early keratectomy within 1 week of admission were compared with a group of 20 patients treated medically. The significance of the association between early keratectomy and visual acuity, progression to perforation, secondary glaucoma and cataract formation, adjuvant therapy, hospitalization days and cost were assessed. There were no differences between the keratectomy and medication groups in regards to age, sex, presence of systemic diseases, and hypopyon formation on presentation. The early keratectomy group had a shorter hospital stay than the medical therapy group. Disease duration was significantly lower in the early keratectomy group (median: 29.0 vs. 54.5 days, P<0.001). Median hospitalization costs per patient were lower with early keratectomy (mean ward fee: 15175.4 vs. 44159.5 NTD, P<0.001; mean donor fee: 0 vs. 900.0 NTD, P<0.001), primarily because of reductions in hospital stay. More patients in the medication group developed perforations than in the keratectomy group (20% vs. 0%, respectively) and the perforation-free rate was higher in those with early keratectomy, but the results were not statistically significant.
Conclusions/Significance:
Early keratectomy in moderate Fusarium keratitis may reduce length of hospital stay, hospital costs, and perforation rates.
Insights
Early keratectomy for Fusarium keratitis significantly reduced hospital stays and costs. While not statistically significant, it also showed a trend towards lower perforation rates compared to medical treatment.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Surgical Interventions
Background:
- Fusarium keratitis is a serious fungal eye infection.
- Moderate cases require careful management to prevent vision loss and complications.
Purpose of the Study:
- To compare treatment outcomes and costs of early keratectomy versus medical management for moderate Fusarium keratitis.
- To evaluate the impact of early surgical intervention on visual acuity, disease progression, and associated costs.
Main Methods:
- Retrospective study of culture-proven Fusarium keratitis cases (2004-2010).
- Comparison of 13 patients undergoing early keratectomy (within 1 week) versus 20 patients receiving medical therapy.
- Analysis of visual acuity, perforation rates, secondary glaucoma, cataract formation, hospitalization duration, and costs.
Main Results:
- Early keratectomy group showed significantly shorter disease duration (median 29.0 vs. 54.5 days) and reduced hospitalization costs.
- No significant differences in age, sex, systemic diseases, or hypopyon.
- A trend towards lower perforation rates in the early keratectomy group (0% vs. 20%) was observed, though not statistically significant.
Conclusions:
- Early keratectomy may be a cost-effective treatment for moderate Fusarium keratitis.
- Surgical intervention can potentially reduce hospital stay and perforation rates.
- Further research may be needed to confirm the statistical significance of reduced perforation rates.
