Combined Application of 5% Natamycin and 0.2% Fluconazole for the Treatment of Fungal Keratitis

Purpose: To observe the clinical efficacy of combined use of 5% natamycin and 0.2% fluconazole for the treatment of fungal keratitis. Methods:A total of 65 cases diagnosed with fungal keratitis by direct smear and/or fungus culture from January 2010 to January 2013 were enrolled in this study.The duration from the onset of symptoms to admission to our ophthalmic center ranged from 9 to 90 d (mean 29.5 ±19.1 d) in the severe group, which significantly differed from the 7 to 36 d (mean 16.6±7.1 d) in the non-severe group (P<0.01). All cases were divided into non-severe and severe groups based on the degree of corneal inflammation. All cases were treated with topical use of 5% natamycin and 0.2% fluconazole once per hour. The same clinical and examination protocols were adopted for both groups. Results:In the non-severe group,23 of the 24 patients (95.8%) were healed, and 1 (4.2%) showed treatment effica cy. In the severe group,12 of 41 patients (29.3%) were healed, 11(26.8%) showed clinical efficacy, and 18(43.9%) showed no efficacy. The patients between two groups significantly differed in terms of efficacy (P<0.01). Conclusion:Combined use of 5% natamycin and 0.2% fluconazole is efficacious in treating fungal keratitis, especially mild or moderate infections.

Topographical Evaluation of the Decentration of Orthokeratology Lenses

Purpose: To evaluate the amount of lens decentration and various factors affecting decentration after orthokeratology lens wear and to observe the effect of decentration on the visual functions.Methods: Two kinds of orthokeratology lenses were fitted to 270 eyes of 135 patients [initial mean refractive error: (-3.98±1.51)D]. Humphery Instruments ATLAS 990 was used for the computer-assisted analysis of corneal topographical maps. The examination of corneal topography was performed on patients before and after 6 months of wearing orthokeratology lenses. The amount of decentration of orthokeratology lenses was measured by finding the distance between center of optic zone and the pupil center. The factors influencing the amount of decentration were analyzed, including the initial refraction error, astigmatism, keratometry values, corneal eccentricity, and the diameter of lens.Visual symptoms including monocular diplopia, glare around lights were recorded to evaluate the effects of decentration on visual functions.Results: The mean amount of decentration was (0.49±0.34) mm after one night's wear.The mean amount of decentration after 1 month, 3 months and 6 months was (0.57±0.41) mm, (0.55±0.48) mm and (0.59±0.39) mm, respectively. After one month, the amount of decentration was less than 0.50 mm in 51.1% eyes, 0.50～1.0 mm in 35.6% eyes and more than 1.00 mm in 13.3% eyes. The direction of decentration of more than 0.50 mm was mainly in the temporal quadrant (48.5%). Patients with greater initial astigmatism and smaller lenses showed greater decentration (P＜0.05). There was no statistically significant difference in decentration between the two groups with different corneal eccentricities and keratometry values (P＞0.05). The amount of decentration was greater in patients who complained of monocular diplopia and glare.Conclusions: The amount of decentration of orthokeratology depends on the initial refractive error, astigmatism and the design of orthokeratology lenses. Improvement in fitting technology and lens design can lead to reduced incidence of decentration and visual symptoms.