Modified ulcer debridement in the treatment of the superficial fungal infection of the cornea

AIM： To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS： A total of 209 patients（209 eyes） with fungal keratitis, involving no more than 50% of the stromal depth and not responding to antifungal agents for 2 wk, were recruited in this retrospective, noncomparative study. The patients were treated with modified corneal ulcer debridement. All visible corneal infiltrates were removed under an operating microscope to obtain a clean stromal bed and smooth incised edges. Antifungal drugs were used immediately after surgery. Healing time of the ulcers was recorded. Fungal recurrence, visual acuity, corneal thickness and risk factors for treatment failure were monitored.RESULTS： The follow-up was 13.6±5.8m o. The corneal ulcers healed in 195 of 209 eyes（93.3%）, with a mean healing time of 8.4±6.8 d. The other 14 eyes were further treated by penetrating keratoplasty（PK）（1 eye）, anterior lamellar keratoplasty（LK）（7 eyes）, conjunctival flap covering（4 eyes） or amniotic membrane transplantation（2 eyes）. The best corrected visual acuity（BCVA） was ≥20/70 in 80.3% of the eyes, ≥20/40 in 56.9% of the eyes, and ≥20/25 in 27.3% of the eyes. The corneas at the lesions became thinner, but all in the safe range. No fungal recurrence or corneal ectasis developed during the follow-up. The risk of treatment failure was higher in patients with preoperative hypopyon（P=0.036） and ever using steroid（P=0.025）.CONCLUSION： Modified surgical debridement is a simple and effective method for the treatment of superficial fungal infection of the cornea, with improved visual acuity and no recurrence. Such an intervention in time can rapidly control fungal infection and largely shorten corneal ulcer healing time.

Efficacy and safety of itraconazole use in infants

Background:Itraconazole has been used to treat fungal infections,in particular invasive fungal infections in infants or neonates in many countries.Data sources:Literature search was conducted through Ovid EMBASE,PubMed,ISI Web of Science,CNKI and Google scholarship using the following key words:“pediatric”or“infant”or“neonate”and“fungal infection”in combination with“itraconazole”.Based on the literature and our clinical experience,we outline the administration of itraconazole in infants in order to develop evidence-based pharmacotherapy.Results:Of 45 articles on the use of itraconazole in infancy,13 are related to superficial fungal infections including tinea capitis,sporotrichosis,mucosal fungal infections and opportunistic infections.The other 32 articles are related to systemic fungal infections including candidiasis,aspergillosis,histoplasmosis,zygomycosis,trichosporonosis and opportunistic infections as caused by Myceliophthora thermophila.Conclusion:Itraconazole is safe and effective at a dose of 5 mg/kg per day in a short duration of therapy for superficial fungal infections and 10 mg/kg per day for systemic fungal infections in infants.With a good compliance,it is cost-effective in treating infantile fungal infections.The profiles of adverse events induced by itraconazole in infants are similar to those in adults and children.