Preliminary investigation of optical full-thickness lamellar keratoplasty for fungal keratitis

Abstract

Objective To investigate the efficacy and safety of optical full-thickness lamellar keratoplasty （OFLK） with eryopreserved donor corneas in the treatment of fungal keratitis. Methods OFLK was performed on 21 eyes of 21 patients with fungal keratitis that had not been cured by antifungal chemotherapy. Fungal hyphae and the infiltrating depth in all 21 corneas were confirmed by laser confocal microscopy before surgery. During the surgery, corneal stroma was removed and Descemet membrane was exposed by a completely blunt dissection with the use of a very fine forceps tip and a fine blunt spatula. Visual acuity, corneal clarity, and endothelium cell density were assessed at different time points after surgery. Results Fungal hyphae were imaged in all of the 21 patients and no filaments were found infiltrated in the deep stroma and Descemet membrane preoperatively. No intra-operative perforation of Descemet membrane occurred during surgery. Twenty cases resulted in the successful cure of fungal infection and were followed up for （14±6）months. Only one eye （4.76%） had a recurrence of the fungal infection within 2 weeks. The best-corrected visual acuity （BCVA）of 14 cases was above 4.5, 5 of which were above 4.8 at 6 months after surgery. Overall, mean endothelium cell density was （2337±357）cells/mm^2 （range 1016-3380 cells/mm^2） at 12 months after surgery. Conclusion OFLK is a safe and effective therapy for restoring visual acuity in the treatment of fungal keratitis. Laser confocal microscopy is helpful in the diagnosis of fungal keratitis and in judging the depth of the filament infiltration. Blunt separation decreases the percentage of intra-operative perforation of Descemet membrane. Key words: confocal microscopy; fungal keratitis; lamellar keratoplasty