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Aggressive Debridement Improves Outcome of Fungal Keratitis
Peter Zloty1, Ovette Villavicencio, Michael W Belin
1From the *University of South Alabama, Mobile, AL; and †Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ.
Purpose:
To study surgical debridement in the management of fungal keratitis in 44 patients.
Design:
A prospective randomized study.
Methods:
Patients with presumed fungal keratitis were randomized into 2 groups. The first group had diagnostic corneal scraping with a Kimura spatula while the second group underwent surgical debridement utilizing a motorized drill with attached diamond burr. Material obtained from both methods was plated on Sabaurauds medium, blood agar and stained for bacteria and fungi. Topical and systemic antifungal therapy was instituted, and patients were examined until resolution.
Results:
Pathogens were identified to a greater degree in the aggressive debridement group than in the Kimura spatula group. Patients who had aggressive debridement had a significant reduction in time to re-epithelialization and keratitis resolution (9.4 days) compared with the scraping group (17.1 days, P < 0.001). Mean uncorrected visual acuity (UCVA) in the surgical group was 1.02 logarithm of the minimal angle of resolution (logMAR) preoperatively and 0.43 logMAR postoperatively (P < 0.001). Mean UCVA in the Kimura spatula group was 1.20 logMAR before and 0.58 logMAR after scraping (P = 0.03). A single incidence of perforation occurred in the scraping group with the diagnosis of Fusarium made from the corneal button.
Conclusions:
Aggressive debridement and debulking of fungal keratitis provides a faster clinical resolution with no reduction in visual potential. The acquisition of pathogens is more accurate with surgical debridement as compared with conventional scraping. Aggressive surgical debridement of keratitis not only aids in diagnosis but may also be therapeutic.
