Canadian journal of ophthalmology. Journal canadien d'ophtalmologie · 2013
Minimal trephination penetrating keratoplasty for severe fungal keratitis complicated with hypopyon.
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Liu Yang, Jia Hui, Shi Xiaoru, Wang Jiao, Ning Yan, He Bing, Wang Chunmei, Zheng Xiaodong
Аннотация
OBJECTIVE: To report outcomes after minimal trephination penetrating keratoplasty (PKP) in the treatment of severe fungal keratitis complicated with hypopyon.
DESIGN: Retrospective case series.
PARTICIPANTS: Series of 19 eyes in 19 patients with severe fungal keratitis complicated with hypopyon that received minimal trephination PKP.
METHODS: The host trephination was made equal to or smaller than the margin of the corneal lesion. Fluconazole (0.2%) was used to irrigate the trephined edge and anterior chamber during surgery, followed by irrigation of the anterior chamber with a 0.02% fluconazole solution after graft transplantation. Postoperative complications, graft rejection, transparency rate, and visual acuity were recorded.
RESULTS: Patients were followed postoperatively for 18 to 34 months (mean 28.6 months). At 18 months after PKP, 18 grafts (94.7%) remained clear and 14 eyes (73.7%) had improved visual acuity. Three eyes (15.8%) with secondary glaucoma complications after PKP were treated with subsequent trabeculectomy. Recurrent infection was found in only 1 eye (5.26%) after transplantation and was successfully managed. Immune graft rejections were not observed in any patient during the follow-up period.
CONCLUSIONS: The minimal trephination technique in combination with antifungal therapy was effective in the treatment of severe fungal keratitis with large corneal lesions and hypopyon.
DESIGN: Retrospective case series.
PARTICIPANTS: Series of 19 eyes in 19 patients with severe fungal keratitis complicated with hypopyon that received minimal trephination PKP.
METHODS: The host trephination was made equal to or smaller than the margin of the corneal lesion. Fluconazole (0.2%) was used to irrigate the trephined edge and anterior chamber during surgery, followed by irrigation of the anterior chamber with a 0.02% fluconazole solution after graft transplantation. Postoperative complications, graft rejection, transparency rate, and visual acuity were recorded.
RESULTS: Patients were followed postoperatively for 18 to 34 months (mean 28.6 months). At 18 months after PKP, 18 grafts (94.7%) remained clear and 14 eyes (73.7%) had improved visual acuity. Three eyes (15.8%) with secondary glaucoma complications after PKP were treated with subsequent trabeculectomy. Recurrent infection was found in only 1 eye (5.26%) after transplantation and was successfully managed. Immune graft rejections were not observed in any patient during the follow-up period.
CONCLUSIONS: The minimal trephination technique in combination with antifungal therapy was effective in the treatment of severe fungal keratitis with large corneal lesions and hypopyon.