[Morphofunctional analysis of the efficiency of keratoplasty in the treatment of keratomycosis].

BACKGROUND

Keratoplastic surgery is an efficient treatment for serious keratomycosis, therefore these should be applied more often. The keratomycosis (mycotical keratitis) is a rare, but severe illness of the eye, since it is discovered often in a late stage and is challenging to cure. In these cases the accurately timed keratoplasty is very helpful. In this morphofunctional analysis the procedure of keratoplastic treatment and the efficiency of treatment of the keratomycosis were evaluated.

METHODS

From January until November 2010 eight patients with microbiologically evident mycoses were treated operatively and conservatively by surgeons. The removed tissues were fixated in buffered formalin and embedded in paraffin. About 0.5 µm thin paraffin sections were analysed histologically and histochemically and evaluated semiquantitatively. Postoperatively all patients have been treated antimycotically for 7 until 10 days.

RESULTS

The most important step for keratoplastic treatment was to remove the affected tissue completely and to treat with radical surgery in all cases. In this process the cornea was replaced by 3-mm and 5-mm pieces of sclera. The histological analysis of the eye after evisceration showed a complete destruction under the epithelium caused by the connective tissue-cellular proliferation. Postoperatively the topical, systemic and antimycotic therapy was continued for 30 days. In three cases the cortisone therapy was used for three to six days after surgery.

CONCLUSIONS

After successful keratoplastic treatment an improvement of the acuteness and either an improvement of vision about 60 to 70 percent of the transparent regeneration were observed in all cases. To avoid recurrences for therapeutically keratoplastic treatment, radical removal of the injured tissue is necessary. Suppression of inflammations inside the treated eye was accelerated by systemic and topical application of corticosteroids, which influenced the condition of the transplants in a positive way.