Abstract

THERAPEUTIC KERATOPLASTY IN FUNGAL KERATITIS

Author(s): Srinivas1, Dakshayani2

ABSTRACT: BACKGROUND: Fungal keratitis is one of the most difficult form of microbial keratitis for an ophthalmologist to diagnose and treat. It is challenging to treat a case of fungal keratitis and there has been an increase in number of fungal keratitis due to inadvertent use of antibiotics and steroids.1 AIMS & OBJECTIVES: To study and analyze the results of therapeutic keratoplasty in treatment of fungal keratitis. MATERIALS & METHODS: This is a hospital-based clinical study of 20 patients with fungal corneal ulcer refractive to medical line of management attending outpatient department and cornea clinic at Regional Institute of Ophthalmology, Minto Ophthalmic Hospital B.M.C. These cases were treated surgically with therapeutic keratoplasty and their results were analyzed with respect to the efficacy of the procedure in curing the disease, maintenance of structural integrity of the globe, visual rehabilitation & usefulness of the procedure as a bed for future optical keratoplasty. RESULT: Out of 20 patients underwent TKP for fungal keratitis males predominated among those affected amounting to 12 eyes (60%) incidence, mean age of presenting being 41-50 yrs in 7 cases (35%), 17 of the 20 patients (85%) of them being outdoor workers and related to agricultural occupation, 15 of them (75%) had a positive history with vegetative matter, 16 cases (80%) presented with perforation. The globe integrity was maintained in 18 (90%) of patients, visual outcome poor in the range of PR accuracy in 16 eyes (80%), HM in 2 eyes (10%), PL – in 2 eyes (10%). Complications following the procedure included PED in 13 eyes (65%) which was reversible, secondary glaucoma in 7 eyes (35%) managed medically, iris prolapsed in 2 eyes (10%), wound leak in 9 eyes (45%) of cases due to loose suture that was resutured. One case went for phthisis bulbi. One patient did not come for follow-up. None of the cases showed recurrence. INTERPRETATIONS & CONCLUSIONS: Fungal corneal ulcer presents late to the ophthalmologist as the signs are more than symptoms, more common in rural patients, associated with outdoor workers more so those related to agricultural occupation, positively related to injury with vegetative matter. Treatment with TKP in severe fungal keratitis (perforated fungal keratitis and limbal involvement) graft rejection is seen in all the cases with poor visual outcome but with maintenance of structural integration. Hence TKP is a ray of hope for further optical keratoplasty.