Debridement combined with conjunctival flap covering for the treatment of fungal keratitis

Abstract

Objective To investigate the effect of focal cleaning combined with conjunctival flap covering on the treatment of fungal keratitis. Methods Twenty-eight eyes of 28 cases diagnosed with fungal keratitis were retrospectively analysed. After using anti-fungal drugs for 5 to 7 days, all cases did not get better or grew worse. Then focal debridement combined with conjunctival flap covering were performed. Under local anesthesia, necrotic tissues were excised from 1mm away from the infiltrative edge, to where normal corneal tissue exposed. The upwarping zone around the ulcer lesion was removed to make the surface smooth. The size and shape of conjunctival flap were dicided by the area and location of corneal ulcer.Tongue-shape flaps were used for peripheral ulcer, bridge-shape flaps were choosed if ulcer located in the corneal centre, and the whole cornea should be covered if ulcer infiltrated all around the cornea. Results The follow-up period was from 1 month to 6 months. Ulcer of 27 cases(96.43%) were healed and did not recur. The remaining one (3.57%) was under serious condition, and two weeks after operation the ulcer infiltrated into the corneal deep layer and spread to the inside of the eye. Eventually the patient lost the eye. Conclusion This kind of operation is simple, convenient, low cost and especially suitable for primary level hospital, which can effectively reduce the damage and blindness caused by fungal corneal ulcer. Key words: Corneal ulcer, fungal; Debridement; Covering surgery, conjunctival flap