Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment

Eiichi Uchio,1 Yusuke Saeki,1 Tomoko Tsukahara-Kawamura,1 Kazuaki Kadonosono,2 Hiroaki Ozaki1 1Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan; 2Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, JapanCorrespondence: Eiichi UchioDepartm...

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Autores principales:	Uchio E, Saeki Y, Tsukahara-Kawamura T, Kadonosono K, Ozaki H
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	fungal keratitis lamellar keratoplasty fusarium candida therapeutic keratoplasty Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/ebe31101e1564b7d9c5ca7b3fb1de1c5
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spelling	oai:doaj.org-article:ebe31101e1564b7d9c5ca7b3fb1de1c52021-12-02T03:41:17ZClinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment1177-5483https://doaj.org/article/ebe31101e1564b7d9c5ca7b3fb1de1c52019-09-01T00:00:00Zhttps://www.dovepress.com/clinical-outcome-after-air-assisted-manual-deep-anterior-lamellar-kera-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Eiichi Uchio,1 Yusuke Saeki,1 Tomoko Tsukahara-Kawamura,1 Kazuaki Kadonosono,2 Hiroaki Ozaki1 1Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan; 2Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, JapanCorrespondence: Eiichi UchioDepartment of Ophthalmology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, JapanTel +81 92 801 1011Fax +81 92 865 4445Email euchio@fukuoka-u.ac.jpPurpose: Fungal keratitis remains an important disorder because of difficulty in its diagnosis, and some patients do not respond to medical treatment using antifungal local and systemic agents. This study was carried out to determine the therapeutic value of air-assisted manual therapeutic deep anterior lamellar keratoplasty (TDALK) in the treatment of fungal keratitis not curable by antifungal chemotherapy.Methods: Seventeen patients (18 eyes) who were referred to Fukuoka University Hospital and treated surgically from January 2006 to April 2018, in whom a diagnosis of fungal keratitis was confirmed by typical clinical findings and microbiological or histological analysis of corneal specimens, and who were poorly responsive to topical and systemic antifungal medication, whereas the lesion had not resulted in corneal perforation, were enrolled in this study and were treated by air-assisted manual TDALK. Clinical outcomes including treatment course, therapeutic success rate, visual acuity outcomes and graft clarity rate were analyzed.Results: The most common pathogen was Fusarium, followed by Candida and Aspergillus. Beneficial therapeutic results (a clear or translucent graft) were achieved in 15 of 18 eyes (83%). There was no recurrence of infection and resulting visual acuity ≤0.15 logarithm of minimal angle of resolution unit was achieved in 15 eyes (83%). Intraoperative microperforation of Descemet’s membrane (DM) was not observed in any patients.Conclusion: Air-assisted manual TDALK can be effective for treating severe fungal keratitis. In addition, air-assisted manual TDALK might be an alternative procedure to big-bubble DALK, because it can provide ambulatory vision and can preserve potentiality of vision with less risk of intraoperative perforation of DM.Keywords: fungal keratitis, lamellar keratoplasty, fusarium, candida, therapeutic keratoplasty  Uchio ESaeki YTsukahara-Kawamura TKadonosono KOzaki HDove Medical Pressarticlefungal keratitislamellar keratoplastyfusariumcandidatherapeutic keratoplastyOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 1913-1919 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	fungal keratitis lamellar keratoplasty fusarium candida therapeutic keratoplasty Ophthalmology RE1-994
spellingShingle	fungal keratitis lamellar keratoplasty fusarium candida therapeutic keratoplasty Ophthalmology RE1-994 Uchio E Saeki Y Tsukahara-Kawamura T Kadonosono K Ozaki H Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment
description	Eiichi Uchio,1 Yusuke Saeki,1 Tomoko Tsukahara-Kawamura,1 Kazuaki Kadonosono,2 Hiroaki Ozaki1 1Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan; 2Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, JapanCorrespondence: Eiichi UchioDepartment of Ophthalmology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, JapanTel +81 92 801 1011Fax +81 92 865 4445Email euchio@fukuoka-u.ac.jpPurpose: Fungal keratitis remains an important disorder because of difficulty in its diagnosis, and some patients do not respond to medical treatment using antifungal local and systemic agents. This study was carried out to determine the therapeutic value of air-assisted manual therapeutic deep anterior lamellar keratoplasty (TDALK) in the treatment of fungal keratitis not curable by antifungal chemotherapy.Methods: Seventeen patients (18 eyes) who were referred to Fukuoka University Hospital and treated surgically from January 2006 to April 2018, in whom a diagnosis of fungal keratitis was confirmed by typical clinical findings and microbiological or histological analysis of corneal specimens, and who were poorly responsive to topical and systemic antifungal medication, whereas the lesion had not resulted in corneal perforation, were enrolled in this study and were treated by air-assisted manual TDALK. Clinical outcomes including treatment course, therapeutic success rate, visual acuity outcomes and graft clarity rate were analyzed.Results: The most common pathogen was Fusarium, followed by Candida and Aspergillus. Beneficial therapeutic results (a clear or translucent graft) were achieved in 15 of 18 eyes (83%). There was no recurrence of infection and resulting visual acuity ≤0.15 logarithm of minimal angle of resolution unit was achieved in 15 eyes (83%). Intraoperative microperforation of Descemet’s membrane (DM) was not observed in any patients.Conclusion: Air-assisted manual TDALK can be effective for treating severe fungal keratitis. In addition, air-assisted manual TDALK might be an alternative procedure to big-bubble DALK, because it can provide ambulatory vision and can preserve potentiality of vision with less risk of intraoperative perforation of DM.Keywords: fungal keratitis, lamellar keratoplasty, fusarium, candida, therapeutic keratoplasty
format	article
author	Uchio E Saeki Y Tsukahara-Kawamura T Kadonosono K Ozaki H
author_facet	Uchio E Saeki Y Tsukahara-Kawamura T Kadonosono K Ozaki H
author_sort	Uchio E
title	Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment
title_short	Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment
title_full	Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment
title_fullStr	Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment
title_full_unstemmed	Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment
title_sort	clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/ebe31101e1564b7d9c5ca7b3fb1de1c5
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Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment

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