Abstract | PURPOSE: DESIGN: Retrospective, interventional case series. PARTICIPANTS: METHODS: All patients failed to respond to topical and systemic antifungal drugs treatment before corneal transplantation. A trephine that was 0.5 mm larger in diameter than the infection area was used during PK or LK. Medical records of each patient were reviewed retrospectively. The species of pathogenetic fungi causing recurrence were analyzed. The clinical features, including recurrence time, position, symptom, and physical signs, were summarized. Based on clinical features, appropriate topical and systemic antifungal treatment was determined for all patients; some patients also received combined subconjunctival or intracameral injection of fluconazole. If there was treatment failure, a conjunctival flap or keratoplasty was performed. MAIN OUTCOME MEASURES: RESULTS: Fifty-seven patients (6.34%) experienced recurrence after corneal transplantation. There was no difference between PK (6.79%) and LK (5.96%) in recurrence rate (P = 0.883). A higher rate of recurrences was found in those with preoperative hypopyon (10.90%), corneal perforation (12.00%), corneal infection expanding to limbus (20.69%), or lens infection with extracapsular cataract extraction (50%; P<0.05). The 3 main kinds of recurrence were: (1) recurrent infection from recipient bed to graft, and once recurrent infection invaded the graft, the inflammation progressed more rapidly; (2) white mushroom-shaped hypopyon with anterior chamber recurrence; (3) infection in the posterior chamber and vitreous opacity on posterior segment recurrence. Location of recurrence was: recipient bed (70.18%), anterior chamber (7.02%), and posterior segment (22.81%). The overall cure rate was 82.46%, which included drug therapy (28.07%) and surgical treatment (54.39%). CONCLUSIONS:
|
Authors | Weiyun Shi, Ting Wang, Lixin Xie, Suxia Li, Hua Gao, Juncai Liu, Huiping Li |
Journal | Ophthalmology
(Ophthalmology)
Vol. 117
Issue 5
Pg. 890-6
(May 2010)
ISSN: 1549-4713 [Electronic] United States |
PMID | 20079930
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
|
Copyright | Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. |
Chemical References |
|
Topics |
- Adolescent
- Adult
- Aged
- Antifungal Agents
(administration & dosage)
- Child
- Corneal Transplantation
- Corneal Ulcer
(diagnosis, drug therapy, microbiology)
- Eye Infections, Fungal
(diagnosis, drug therapy, microbiology)
- Female
- Fungi
(isolation & purification)
- Humans
- Keratoplasty, Penetrating
- Male
- Microscopy, Confocal
- Middle Aged
- Postoperative Complications
- Recurrence
- Retrospective Studies
- Risk Factors
- Treatment Outcome
|