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.

Rapid corneal thinning and perforated ulcerative keratitis in a patient with relapsing polychondritis

Background:To report rapid corneal thinning and perforation in a case with relapsing polychondritis.Case presentation:A 43 year-old male diagnosed with relapsing polychondritis suffered from bilateral scleritis,bilateral swelling of pinna,saddle nose and tracheal stenosis.The patient presented with right eye pain and redness for one month.Slit lamp examination of the right eye showed 80%peripheral corneal thinning between 3 and 7 o’clock.The best-corrected visual acuity(BCVA)was 1.0 bilaterally.The degree of corneal thinning worsened to 90%after one week of oral corticosteroid use.Subsequently,topical cyclosporine 2%eye drops four times a day,oral doxycycline 100 mg twice a day and oral vitamin C 2 g daily were added.The corneal thinning gradually improved to about 60%.However,the patient rapidly tapered oral prednisolone against medical advice and returned with an acute drop in vision in his right eye.Slit lamp examination of the right eye showed peripheral corneal perforation with iris prolapse.An emergency repair with cyanoacrylate glue was performed.Intravenous methylprednisolone 1 mg/kg body weight was administered for three days and 1 g/day intravenous immunoglobulin was administered every four weeks.At 3 months postoperatively,BCVA in the right eye was 0.6.Slit lamp examination showed a well-formed anterior chamber with glue in situ.Conclusions:Relapsing polychondritis may be associated with rapid corneal thinning.The clinicians should be aware of the possibility of corneal perforation in these cases.Cyanoacrylate glue is a viable temporary management option in such scenarios.

Prolonged conjunctivitis mimicking nodular episcleritis as a manifestation of granulomatosis with polyangiitis-a case report

Red eye is common in our daily practice.It ranges from non-inflammatory to inflammatory causes.An extended course of disease should prompt suspicion and the possibility of diagnosis revision.A prolonged conjunctivitis mimicking nodular episcleritis can be presented as a manifestation of granulomatosis with polyangiitis(GPA).A 57-year-old woman complained of eye redness and tearing for two weeks which partially resolved with antibiotics.She was subsequently commenced on topical and oral non-steroidal anti-inflammatory drugs(NSAIDs)and topical anti-allergic.However,in the following reviews she developed cornea thinning and her systemic examination revealed an injected uvula with absence of upper respiratory tract infection.She was investigated for connective tissue disease and found to have raised anti-inflammatory markers and her antinuclear antibody and C-ANCA tests were positive.She was diagnosed with GPA.Her conditions improved followed by the commencement of topical corticosteroid with high dose of systemic corticosteroid,which followed by a tapering regime with oral corticosteroid.Although red eye is common,it is associated with a variety of diseases.GPA manifestation can be as subtle as a red eye.Any prolonged partially treated red eye should prompt suspicion of a more sinister cause.Sensitive detection of other subtle systemic signs is very important.