Indian Journal of Clinical and Experimental Ophthalmology


Factors influencing healing of fungal keratitis under treatment: A clinical study


Full Text PDF Share on Facebook Share on Twitter


Author Details: Ramyash Singh Yadav, Brij Mohan Rao, Praveen Kumar, Akash Srivastva

Volume : 2

Issue : 3

Online ISSN : 2395-1451

Print ISSN : 2395-1443

Article First Page : 278

Article End Page : 284


Abstract

Purpose: To study the local and general factors influencing healing of fungal keratitis.

To evaluate the effects of various antimycotic treatment regimens of fungal keratitis.
Method: The patients were taken up from those attending the out-patient department of ophthalmology of Nehru hospital attached to B.R.D Medical College Gorakhpur from June 2006 to October 2007. All cases of corneal ulcer with clinical features of fungal keratitis and cases of corneal ulcer with positive 10% potassium hydroxide mount1,2 were selected, detailed history taken and examination done under (a) general examination, (b) systemic examination and detailed ocular examination along with blood investigations and 10% potassium hydroxide mount1,2 preparation. 
Treatment evaluation and follow up was done regularly for the period of one month, progression and treatment response noted and parameters were recorded .the ulcer was taken:
Healed: If the epithelial defect had healed with negative fluorescein staining and there was no progressive stromal infiltration.
Delayed healing: If the size of ulcer decreased but not fully healed and still require further active treatment and
Failed: If the size of ulcer remained same or increased or ulcer got perforated requiring active surgical intervention.
Result: 47 pts were included in study, 5 patients did not turn up. 18 patients (42.86%) leave the study with successful healing of corneal ulcer, 9 patients (21.43%) required further treatment due to delayed healing response and treatment failure occurred in 15 patients(35.71%) requiring active surgical treatment in form of conjunctival hooding, Amniotic membrane graft, evisceration etc.
Conclusion: From the observation of this study it can be concluded that fungal keratitis is a suppurative, ulcerative disease of cornea, with a poor visual outcome even with the best efforts due to inability of highly sensitive and specific tools. Disease is more common in patients with reduced immunity, trauma with vegetative matter, low socio-economic status and injudicious use of steroids. There is also big lack of specific and effective fungicidal drugs. All available anti-fungal drugs are very slow acting and prevent the growth of fungus only, without killing it.
At present the most effective drug is topical 5% Natamycin, which is also fungi-static and slow acting.

Keywords:
Fungal keratitis, Healed corneal ulcer, Poor visual outcome, Natamycine