Clinical characteristics,risk factors,and prognoses of fungal keratitis caused by three common fungal species in Northern China

Background:To evaluate the clinical characteristics,risk factors,and treatment outcomes of fungal keratitis(FK)caused by three common fungal species in northern China.Methods:A total of 203 cases of FK caused by Fusarium,Aspergillus or Alternaria treated at Shandong Eye Institute were included.Clinical features were analyzed in the following aspects:(I)risk factors,including physical trauma,ocular surface diseases,contact lens wear,and non-identified risk factors;(II)clinical manifestations;(III)treatment approaches and prognosis.Results:There were 151 cases of Fusarium keratitis,35 cases of Aspergillus keratitis,and 17 cases of Alternaria keratitis.Trauma(71.9%)ranked first among the risk factors for all 3 kinds of FK(P=0.015).Plant matter was most common in FK caused by Fusarium(54.1%)and Alternaria(63.6%),while grit was predominant in Aspergillus keratitis(61.5%).The main clinical manifestations were pseudopodia(74.2%in Fusarium keratitis and 64.7%in Alternaria keratitis)and hypopyon(51.4%in Aspergillus keratitis).The lesion area was less than 10 mm2 in 64.7%of Alternaria infection and more than 10 mm2 in 60.9%of Fusarium infection.Recurrence was found in Fusarium(9.9%)and Aspergillus(5.7%)keratitis,but not in Alternaria keratitis.Conclusions:FK associated with Fusarium,Aspergillus,and Alternaria seems to have various risk factors,clinical characteristics,and prognoses.Awareness of the specific differences may help to guide the clinical treatment before the results of culture and susceptibility testing are available.

Photoshop软件设计指导的飞秒激光辅助DLK治疗圆锥角膜

目的:观察Photoshop软件个性化设计指导的飞秒激光辅助深板层角膜移植术(DLK)治疗圆锥角膜的有效性和准确性。方法:前瞻性干预性非随机对照研究。连续收集山东第一医科大学附属眼科医院2016年12月至2018年12月因圆锥角膜完成期拟行飞秒激光辅助DLK的患者,分为研究组和对照组。研究组术前应用Photoshop软件测量患者角膜直径,然后个性化设计角膜植床/植片的直径;而对照组植床/植片直径统一设定为7.9/8.2 mm。观察患者术后12个月最佳矫正视力(BCVA)、平均角膜曲率、等效球镜度、平均散光等指标。采用独立样本t检验对数据进行统计学分析。结果:共纳入72例(72眼)患者,其中研究组40例,植床/植片的直径分别为7.9/8.2 mm 6例、8.1/8.4 mm 18例、8.3/8.6 mm 16例;对照组32例,植床/植片直径均为7.9/8.2 mm。术后1周,研究组应用Photoshop软件实际测量的角膜植片直径为(8.4±0.1)mm,与术前个性化设计的植片直径进行对比,二者之间的差异无统计学意义(t=-0.47,P=0.710)。术后12个月,研究组BCVA(LogMAR)为0.44±0.24,较对照组(0.58±0.30)视力更好(t=-2.19,P=0.030);研究组散光为(3.96±2.68)D,相比对照组的(6.30±4.71)D,其散光更小(t=-2.65,P<0.001)。所有患者中均未出现后弹力层破裂、缝线松动、缝线新生血管化、植片免疫排斥反应等并发症。结论:应用Photoshop软件个性化设计角膜植床/植片直径的方法具有较高的准确性和可预测性,可以显著改善圆锥角膜患者DLK后的屈光状态。