Treatment Of Fungal Corneal Ulcer Research Articles

Oriented cellulose hydrogel: Directed tissue regeneration for reducing corneal leukoplakia and managing fungal corneal ulcers

Fungal corneal ulcer is one of the leading causes of corneal blindness in developing countries. Corneal scars such as leukoplakia are formed due to inflammation, oxidative stress and non-directed repair, which seriously affect the patients' subsequent visual and life quality. In this study, drawing inspiration from the oriented structure of collagen fibers within the corneal stroma, we first proposed the directional arrangement of CuTA-CMHT hydrogel system at micro and macro scales based on the 3D printing extrusion method combined with secondary patterning. It played an antifungal role and induced oriented repair in therapy of fungal corneal ulcer. The results showed that it effectively inhibited Candida albicans, Aspergillus Niger, Fusarium sapropelum, which mainly affects TNF, NF-kappa B, and HIF-1 signaling pathways, achieving effective antifungal functions. More importantly, the fibroblasts interacted with extracellular matrix (ECM) of corneal stroma through formation of focal adhesions, promoted the proliferation and directional migration of cells in vitro, induced the directional alignment of collagen fibers and corneal stromal orthogonally oriented repair in vivo. This process is mainly associated with MYLK, MYL9, and ITGA3 molecules. Furthermore, the downregulation the growth factors TGF-β and PDGF-β inhibits myofibroblast development and reduces scar-type ECM production, thereby reducing corneal leukoplakia. It also activates the PI3K-AKT signaling pathway, promoting corneal healing. In conclusion, the oriented CuTA-CMHT hydrogel system mimics the orthogonal arrangement of collagen fibers, inhibits inflammation, eliminates reactive oxygen species, and reduces corneal leukoplakia, which is of great significance in the treatment of fungal corneal ulcer and is expected to write a new chapter in corneal tissue engineering.

Different Thicknesses of Acellular Porcine Corneal Stroma on Prognosis of Fungal Corneal Ulcers Treated by Lamellar Keratoplasty: A Five-Year Retrospective Study.

To compare the prognosis and efficacy of acellular porcine corneal stroma (APCS) with different thicknesses for the treatment of fungal corneal ulcers by lamellar keratoplasty (LKP). A total of 52 patients who underwent LKP with APCS for the treatment of fungal corneal ulcers were included in this retrospective study. Patients were divided into 2 groups according to the different thicknesses of APCS (0.30 ± 0.05 mm, L2 group, n = 20; 0.40 ± 0.05 mm, L3 group, n = 32). Observation indicators included best corrected visual acuity, graft transparency, corneal neovascularization, ocular irritation symptoms, corneal epithelial healing time, graft survival, central corneal thickness at 1 year after surgery, and postoperative complications. Compared with the L3 group, the L2 group had better postoperative best corrected visual acuity and graft transparency (P < 0.001), less corneal neovascularization (P < 0.001), and lower incidence of complications (P < 0.05). There were significant differences in ocular irritation symptoms between the 2 groups (P < 0.05) at 3 and 6 months postoperatively, which might be related to the higher recurrence rate and graft rejection rate in the L3 group. The comparison of postoperative epithelial healing time also showed significant differences in 2 groups (P < 0.01). The 1-year survival rate was up to 63.5% in both groups, with no significant difference (P < 0.05). However, the risk of transplantation was less in the L2 group. Both APCS thicknesses could provide adequate central corneal thickness at 1 year after surgery (P > 0.05). APCS was safe and effective in the treatment of fungal corneal ulcers by LKP. Thinner grafts should be preferred for LKP for fungal corneal ulcers to reduce the risk of grafting.

Clinical Observation of Low-Temperature Plasma Ablation Combined with Drug Therapy in the Treatment of Fungal Keratitis.

To observe the efficacy and prognosis of low-temperature plasma ablation + drug therapy in the treatment of fungal corneal ulcers. The present paper presents a retrospective clinical study with a subject base of 34 eyes. Patients with a fungal corneal ulcer who visited the Affiliated Eye Hospital of Nanchang University between August 2019 and December 2021 were selected as the study participants. They were found to have highly reflective fungal hyphae in the corneal stroma layer via confocal microscope examination, which were revealed to be positive on etiology examination, with the ulcer and infiltration depths ≤1/2 of the corneal thickness. The efficacy and prognosis were observed after treatment with low-temperature plasma ablation + drug therapy. A total of 34 cases (34 eyes) had clinical manifestations of corneal infiltration and corneal ulcer formation, with a corneal lesion diameter of 1.31-8.64 mm (average = 4.79 ± 2.03 mm). The average healing time of corneal ulcers was 6.2 ± 1.7 days. Among a total of 34 cases (34 eyes) in patients with fungal keratitis, the infection was controlled and the ulcers gradually healed after treatment with low-temperature plasma system + drug therapy in a total of 30 cases (30 eyes, 88%). A total of three cases (3 eyes, 9%) exhibited no clear improvement after the treatment, and the patients underwent conjunctival flap covering surgery. One case (one eye, 3%) exhibited no clear improvement after further treatment, with the patient experiencing corneal perforation and ultimately undergoing penetrating keratoplasty. Low-temperature plasma ablation + drug therapy can effectively control the progression of fungal keratitis infection, as well as significantly shorten the ulcer healing time, and is, therefore, an effective method.

Comparison of modified corneal cross-linking with intrastromal voriconazole for the treatment of fungal corneal ulcer.

The present study aimed to evaluate the efficacy of modified corneal cross-linking (CXL) for the treatment of fungal corneal ulcers compared with that following intrastromal voriconazole injection. In total, 31 patients with fungal corneal ulcers treated at The General Hospital of Northern Theater Command between October 2017 and October 2019 were enrolled. Among them, 10 eyes were treated with ultraviolet A (UV-A)/riboflavin CXL (CXL group), whilst 21 eyes were treated with debridement combined with intrastromal voriconazole (stromal injection group). Preoperative microbiological examination was performed in both groups, and evaluated using Fisher's exact test. Postoperatively, infection control and total efficacy rates, localized lesion, ulcer healing rate 1 week after surgery, visual acuity and complications were evaluated using Fisher's exact test, however visual acuity was analyzed by mixed-model ANOVA. The results showed that the pre-operative species distribution between the CXL and stromal injection groups did not significantly differ. The infection control rate in the CXL group was notably higher compared with that in the stromal injection group (P=0.04). Furthermore, the total efficacy rate in the CXL group was also markedly higher compared with that in the stromal injection group, though no statistically significant differences were observed. Localized lesions were observed in nine eyes (90.0%) in the CXL group and nine eyes (42.9%) in the stromal injection group (P=0.02). However, the rate of ulcer healing at 1 week postoperatively and the logarithm of the minimum angle of resolution (logMAR) of visual acuity were not found to be significantly different between the two groups. In terms of complications, with the exception of one patient in the CXL group exhibiting loss of corneal transparency and one patient in the stromal injection group presenting with partial corneal thinning, no other forms of complications were observed. In conclusion, the present study suggested that CXL could have a beneficial impact for treating fungal corneal ulcers in the aspects of infection control, localized lesions and accelerated epithelialization. In addition, except the loss of corneal transparency, this treatment approach could be applied with reduced risks of adverse events.

EFFICACY OF 1% TOPICAL VORICONAZOLE IN THE TREATMENT OF MYCOTIC CORNEAL ULCER : A CLINICAL STUDY

Aim:To evaluate the efcacy of topical Voriconazole in the treatment of fungal corneal ulcer. Materials and methods: It was a single centre prospective tertiary care hospital based study conducted in the Upgraded Department of Ophthalmology at DARBHANGA MEDICAL COLLEGE AND HOSPITAL, Laheriasarai. It included 25 corneal ulcer patients of all demographic and socioeconomic status attending outdoor and/or indoor of Department of Ophthalmology, from April 2019 to April 2020, for a period of one year. Result: Majority of the patients were females.The decrease in ulcer size and improvement in visual acuity post treatment with topical Voriconazole was found to be statistically signicant. Conclusion: Topical therapy with 1% Voriconazole (w/v) served to be an economical mode of treating fungal corneal ulcer. It helped in the early and complete resolution of the ulcer with no adverse effects.

Clinical study and management of the fungal corneal ulceration

Background: The corneal infection of fungal etiology is very common and comprising at least 50% of all culture-positive cases in India. Diagnosis and treatment of fungal corneal ulcers can be quite challenging because of the delay in seeking medical attention due to reduced symptoms in mycotic corneal ulcer and the limited antifungal agents available for ocular use and the deeper extent to which they can penetrate the corneal tissue. Materials and Methods: A study of 80 cases of fungal corneal ulcers was conducted in General Hospital attached to Medical College. A detailed history was taken and a thorough ocular and systemic examination were done. Microbiological work-up of corneal scrapings was done in all patients. All patients were given necessary topical and systemic antifungal drugs, antiglaucoma drugs, cycloplegics, and surgical treatment wherever needed by different consultants and followed up for a period of 8 weeks. Results: At the time of presentation 45% of patients had received different medications especially without microbiological workup. All patients were KOH positive and among them, 65% were culture positive. Different topical treatment combinations were used among them natamycin 5% suspension was used in all patients. Therapeutic penetrating keratoplasty and the conjunctival flap was done in one patient each. Conclusion: Agricultural activity and vegetative matter trauma was the commonest predisposing factor. Following treatment 77.5% ulcers healed with a visually significant corneal opacity, 20 % had perforation all of which were ulcers with full-thickness corneal involvement. In one non-healing ulcer penetrating keratoplasty was done.

Comprehensive treatment of fungal corneal ulcer of different degrees

Comprehensive treatment of fungal corneal ulcer of different degrees

Effect of topical 5% Natamycin in treatment of fungal corneal ulcer: A prospective study in a tertiary care teaching hospital in Telangana

Effect of topical 5% Natamycin in treatment of fungal corneal ulcer: A prospective study in a tertiary care teaching hospital in Telangana

Necessity to identify the causative agent for appropriate treatment in fungal corneal ulcer: an in vitro study

Fungal corneal ulcers are a major cause of preventable blindness. Different antifungal agents as natamycin, nystatin, fluconazole, itraconazole, voriconazole are used to treat these ulcers. Among these, natamycin is most widely used as a treatment modality. In natamycin non-responding cases, other drugs especially voriconazole is used. This study was done to assess the use of antifungal drugs in the treatment of fungal corneal ulcer by determining the minimum inhibitory concentration against common fungal pathogens. Minimum inhibitory concentration of fluconazole, itraconazole, voriconazole, nystatin and natamycin was assessed against the 61 isolated corneal fungal pathogens as per CLSI guidelines. MIC value of different antifungal agents varies as per fungal strains. Voriconazole showed the lowest MIC against the isolated fungi, in comparison to fluconazole and itraconazole. In comparison to other fungi, higher natamycin MIC was observed against Aspergillus species. Itraconazole is poorly effective against Fusarium sp. Identification of causative fungi is necessary before antifungal treatment. Lowest voriconazole MIC promotes its use as 1st line drug. Comparative higher natamycin MIC, especially against Aspergillus species, warns clinician to have MIC in each case of a non-responding fungal corneal ulcer.

Lamellar Keratoplasty Treatment of Fungal Corneal Ulcers With Acellular Porcine Corneal Stroma

The fundamental problem of corneal transplantation is a severe shortage of donor tissues worldwide, resulting in approximately 1.5 million new cases of blindness annually. To explore an alternative to donor corneas, we conducted a clinical study in which implanted acellular porcine corneal stromas (APCSs) replaced the pathologic anterior corneas in 47 patients who had experienced fungal corneal infections. Subsequently, we demonstrated the safety and efficacy of APCSs in human keratoplasty for a minimum follow-up period of 6 months, during which time no recurrence of infection was observed. All corneal ulcers healed with the return of neovascularization. In addition, our results indicated that epithelialization occurred in all APCS grafts except four grafts; for these four, the grafts dissolved to varying degrees. Furthermore, most porcine grafts (n = 41) gradually became transparent without rejection, and an improvement of more than two lines in best corrected visual acuity (BCVA) was achieved in 34 eyes (∼72%). Finally, no patients showed any severe adverse reaction or any significant change in postoperative systemic safety indicators. Thus, we concluded that APCS grafts are safe and efficacious during lamellar keratoplasty in treating corneal fungal ulcers and potentially for other clinical diseases.

Experimental study on cryotherapy for fungal corneal ulcer.

BackgroundFungal corneal ulcer is one of the major causes of visual impairment worldwide. Treatment of fungal corneal ulcer mainly depends on anti-fungal agents. In the current study, we developed an integrated combination therapy of cryotherapy and anti-fungal agents to facilitate effective treatment of fungal corneal ulcer.MethodsRabbit models of cornea infection were established using a combined method of intrastromal injection and keratoplasty. After treatment with cryotherapy and anti-fungal agents, scanning electron microscopy, transmission electron microscopy, and confocal microscopy were conducted to observe changes in microstructure in the rabbits. Periodic acid Schiff A and hematoxylin and eosin staining were used for detection of histological changes.ResultsContinuous scanning electron microscopy and transmission electron microscopy observations showed that cryothermal treatment inhibited growth of fungal mycelium by destroying fungal cellular structures. Typical cryotherapy was effective in curing fungal corneal ulcer. Different fungi showed different susceptibilities to treatment. The curative effect of Candida albicans was the best, while that of Aspergillus fumigates was the worst.ConclusionsOur study provides a novel method of a combination of cryotherapy and anti-fungal agents for treatment of fungal corneal ulcer. This treatment could help facilitate the practice of fungal keratitis treatment in the future.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-015-0011-5) contains supplementary material, which is available to authorized users.

Cytotoxic Effect of Voriconazole on Human Corneal Epithelial Cells

Background: To assess the cytotoxic properties of voriconazole and sulfobutylether-β-cyclodextrin (SBECD) on cultured primary human corneal epithelial cells. Methods: Human corneal epithelial cells were cultured and exposed to various concentrations of SBECD (0.016-32 mg/ml) and voriconazole (0.001-2 mg/ml). Cellular cytotoxicity of SBECD and voriconazole on human corneal epithelial cells was evaluated using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide test and the LIVE/DEAD Viability/Cytotoxicity Assay with fluorescence microscopy analysis. Cell damage was assessed with phase-contrast microscopy after 24 h of exposure to SBECD and voriconazole. Results: The cytotoxicity tests and the morphological characteristic demonstrated the dose-dependent toxic effect of SBECD and voriconazole on human corneal epithelial cells. No corneal epithelial cytotoxicity was observed below the concentration of 0.08 and 0.025 mg/ml after 24-hour exposure to SBECD and voriconazole, respectively. Conclusions: The results of the study reveal the dose-dependent cytotoxic effect of SBECD and voriconazole on cultured human corneal epithelial cells. Therefore, voriconazole eye drops should be used cautiously in the treatment of fungal corneal ulcers.

Clinical efficacy of Voriconazole with Natamycin for the treatment of fungal corneal ulcer

Objective To investigate the clinical efficacy of Voriconazole combined with Natamycin for the treatment of fungal corneal ulcer after eye injury. Methods 22 eyes of 22 patients with fungal corneal ulcer were treated with Voriconazole systematically, first day 800 mg/d （400 rag, bid） , then 400 mg/d （200 rag, bid）, for 14-21 days according to the severity, combined with Natamycin eye drops application topically. The initial administration of Natamycin were once an hour. If the clinical symptoms were significantly improved after 14 days, it were reduced to 6 - 8 times/d for 3-4 weeks. If the inflammation subsided, the frequency of administration might be reduced gradually, and maintained for 3 weeks after the mycelium were not found by confocal microscopy. Corneal debridement and iodine tincture cautery were performed. And the efficacy of combined medication were observed. Results 17 eyes were clinically cured （77.27%）. The treatments of 5 eyes were ineffective, in which 3 eyes received evisceration, and 2 eyes received corneal transplantation. No serious adverse drug reaction occured in all patients. Conclusion Systemic medication of Voriconazole combined with Natamycin eye dorps for the treatment of fungal corneal ulcer is safe and effective. It is a new choice for refractory fungal corneal ulcer. Key words: Ulcer,corneal, fungal; Voriconazole; Natamycin; Efficacy

Debridement with conjunctival flap covering for treatment of fungal corneal ulcer

Objective To evaluate the therapeutic outcome of debridement with conjunctival flap covering surgery for different degrees of fungal corneal ulcer.Methods A retrospective analysis was done on 26 eyes of 26 cases of fungal corneal ulcer.They had accepted debridement with conjunctival flap covering surgery.Results 15 eyes in the early stage of corneal ulcer were cured after one surgery.Six eyes recurred in the other 11 eyes with hypopyon recurred.Conclusion Debridement with conjunctival flap covering surgery is effective for early fungal corneal ulcer. Key words: Ulcer, corneal, fungal; Covering, flap, conjunctival; Debridement

Clinical observation of autologous conjunctival flap covering for the treatment of fungal corneal ulcer

Objective To evaluate clinical efficacy of conjunctival flap covering for the treatment of fungal corneal ulcer. Methods 126 patients （126 eyes） diagnosed as fungal corneal ulcer accepted con- junctival flap covering surgery and were followed-up for 6 months after the operation. The vision, recurrence and conjunctival flap transformation were statistically analysed. Results 118 cases（ll8 eyes） were cured （93.65%）. Recurrence of 8 cases （8 eyes, 6.35% ） were observed. 108 eyes （85.71%） obtained better visual acuities. 102 cases （ 102 eyes, 80.95% ） had corneal nebula formation with conjunctival flap vascular atrophy. Conclusion Autologous conjunetival flap covering is an effect method for the treatment of fungal corneal ulcer. Key words: Covering, conjunctival flap, autologous ; Ulcer, corneal, fungal; Nebula, corneal

Voriconazole versus natamycin as primary treatment in fungal corneal ulcers

To evaluate the efficacy of topical 1% voriconazole versus 5% natamycin in treatment of fungal corneal ulcers. A prospective, randomized pilot study in a tertiary care hospital. Thirty patients of microbiologically proven fungal keratitis divided randomly in two groups of 15 patients each. Two groups were treated with either 5% natamycin (group A) or 1% voriconazole (group B) topically as a primary treatment for fungal keratitis. The mean size, depth of infiltrate and LogMAR visual acuity at presentation were comparable in both groups (P > 0.05). Patients were followed up for minimum of 10 weeks or till complete resolution of ulcer, whichever was later. Cultures to identify the causative organisms were performed. Time of resolution of the ulcer. Twenty-nine of the total 30 patients showed complete resolution. Average time of resolution and gain in LogMAR visual acuity was 24.3 days and 1.12 in group A and 27.2 days and 0.77 in group B. These were comparable in the two groups (P > 0.05%). Aspergillus spp. (40%) and Curvularia spp. (30.0%) were found to be most common isolates. Topical 1% voriconazole was found to be safe and effective drug in primary management of fungal keratitis, its efficacy matching conventional natamycin. There was no added advantage of using topical 1% voriconazole over topical natamycin as primary treatment in fungal keratitis.

A clinical study:Treatment of fungal corneal ulcer with deep lamellar keratoplasty using glycerol cryopreserved corneas

目的 探讨甘油冷冻保存的供体角膜行深板层角膜移植术治疗浅、中层真菌性角膜溃疡的手术适应证及临床效果.方法 57例(57眼)经综合抗真菌措施治疗无效的浅、中层真菌性角膜溃疡施行深板层角膜移植术,随访8～24月,观察术后复发率、视力恢复、植片透明及并发症发生情况.结果 57例中,52例治愈,成功率91.23%;5例复发,复发率8.77%.矫正视力0.1～0.2者20眼,0.3～0.5者24眼,＞0.5者13眼.17例出现新生血管;13例发生排斥反应,均得到有效控制.植片全部透明.结论 使用甘油冷冻保存的角膜供体行深板层角膜移植术既能及时去除病变组织,达到治疗目的 ,又有一定的增视效果,对药物治疗无效的浅、中层真菌性角膜溃疡是有效的手术方式。

Clinical study of temporary conjunctival flap affecting healing and neovascularization in the treatment of fungal corneal ulcer

目的 观察临时结膜瓣对真菌性角膜溃疡愈合和角膜新生血管形成的影响.方法 采用随机对照的方法,将真菌性角膜溃疡86例(86眼)分为两组.A组:临时结膜瓣移植组,51例;B组:常规结膜瓣移植组,35例.观察并比较A、B两组的治愈率、治愈时间及角膜新生血管形成率.随访6个月.结果 两组间治愈率差异及治愈时间差异均无统计学意义(P＞0.05),角膜新生血管形成率两组间差异有统计学意义,A组角膜新生血管形成率明显低于B组(P＜0.01).结论 临时结膜瓣能促进真菌性角膜溃疡愈合,并能减少角膜新生血管形成,其疗效优于常规结膜瓣。

Epidemiology and Treatment of Fungal Corneal Ulcers

Epidemiology and Treatment of Fungal Corneal Ulcers

Treatment of fungal corneal ulcer with low temperature kept Cornea

目的 探讨前房内注入透明质酸钠置换房水的低温保存角膜材料进行角膜移植治疗难治的真菌性角膜溃疡的疗效.方法新鲜供体眼球抽出房水,前房注入透明质酸钠后置于-20℃冰箱保存.以此作为供体行治疗性角膜移植治疗31例(31眼)药物治疗无效的真菌性角膜溃疡观察其疗效.结果穿透角膜移植手术31例(31眼),术后平均随访9.2月,手术成功27眼,手术失败4眼,视力提高14眼.结论采用此方法行治疗性角膜移植手术可达到去除病灶,控制炎症的目的,并为再次行增视性手术创造条件。