【Clinical manifestations】.
1, mostly with a history of vegetative corneal trauma (such as tree branches, sugar cane leaves, straw) or a long-term history of hormone and antibiotic use.
2, slow onset, subacute course, irritation symptoms are mild, with visual impairment.
3, corneal infiltration foci are white or creamy white, dense, with a toothpaste-like or tartar-like appearance, with shallow grooves formed by collagen dissolution around the ulcer or an immune ring formed by antigenic antibody reactions. Sometimes pseudopod or satellite-like infiltrative foci are seen next to the foci of corneal infection, and there may be plaque-like deposits behind the cornea. The pus accumulation in the anterior chamber is grayish white, sticky or burnt.
4, in addition to the above common features, some genera of bacteria caused by corneal infection have certain characteristics.
(1) eggplant disease Fusarium keratitis course progresses rapidly, the disease is serious, easy to the deep corneal tissue infiltration, within a few weeks caused by corneal perforation and malignant glaucoma and other serious complications.
(2) Aspergillus spp. symptoms and progression is slower than Fusarium solani, drug treatment is more effective.
(3) Aspergillus spp. corneal infection is characterized by feathery infiltration confined to the shallow stroma, slow progression, better response to natamycin treatment, more curable, low incidence of corneal perforation and other co-morbidities.
(4) filamentous fungi penetrating, mycelium can cross the deep stroma to invade the posterior elastic layer of the cornea, and even into the anterior chamber to invade the iris and intraocular tissue, once into the anterior chamber, the condition becomes extremely difficult to control, its common lesion site in the posterior chamber, confined to the posterior chamber peripheral part between the iris and lens, forming a stubborn fungal iritis and pupillary membrane closure, can be secondary to glaucoma.
5. It can lead to complicating cataract and fungal endophthalmitis.
[Diagnosis
History of corneal plant injury + lesion characteristics + laboratory tests (corneal scraping to find fungi and mycelium, positive fungal culture results or direct detection of fungal pathogens within the lesion by confocal microscopy).
【Treatment】
1.Topical and systemic application of antifungal drugs: Pay attention to the ocular surface toxicity of antifungal drugs during treatment, including conjunctival congestion and edema, punctate epithelial detachment, etc. Drug treatment should be continued for at least 6 weeks.
(1) Topical eye spotting: including polyenes (e.g. 0.25% diclofenac B ophthalmic solution, 5% natamycin), imidazoles (e.g. 0.5% miconazole ophthalmic solution) or pyrimidines (e.g. 1% flucytosine ophthalmic solution). Currently, 0.15% dicloxacillin B and 5% natamycin ophthalmic solution are the first-line agents for antifungal keratitis. The combination of antifungal drugs has a synergistic effect, which can reduce the dosage of drugs and reduce toxic side effects. The more affirmative combination schemes include flucytosine + dicloxacin B or fluconazole, rifampicin + dicloxacin B, etc. Antifungal drugs are used locally once in 1/2h-1h drops to increase the concentration of drugs in the focal area, and antifungal eye ointment is applied at night. After the infection is obviously controlled, the number of uses should be gradually reduced.
(2) Subconjunctival injection: If the disease is serious, subconjunctival injection of antifungal drugs can be used.
(3) Systemic use: such as intravenous miconazole 10-30mg/(kg.d), divided into 3 doses, each dosage generally does not exceed 600mg, each drip time for 30-60 minutes. Also available 0.2% fluconazole 100mg intravenously.
2. In cases of complicated iridocyclitis, 1% atropine eye drops or eye ointment should be used to dilate the pupil. Glucocorticoids should not be used.
3.Topical and systemic application of quinolones: such as levofloxacin and ofloxacin ophthalmic solution or ophthalmic ointment
4.Surgical treatment: Even if the diagnosis is clear and the medication is timely, there are still 15-27% of patients whose condition cannot be controlled, then surgical treatment should be considered, including debridement, conjunctival flap masking and corneal transplantation.
Prognosis]
1, the disease has been controlled when the lesion is limited, can obtain a better prognosis.
2, if there is corneal perforation or fungus has invaded the anterior chamber causing fungal endophthalmitis, the prognosis is very poor, even leading to the removal of the eye.