[A retrospective medical history analysis of the patients with severe fungal keratitis].
OBJECTIVE
To investigate the cause of delayed diagnosis and treatment in severe fungal keratitis.


METHODS
Retrospective analysis of the treatment history was performed in patients with severe fungal keratitis which attended to our hospital during 2000 to 2001. The main parameters evaluated were nature of access with the health care services, examinations undertaken, initiated treatment, and the time interval between presentation to each medical contact and to our center. Finally, the management undertaken at our center was evaluated.


RESULTS
69 patients (eyes) were enrolled into this investigation, of which 86% (59/69) was local residents in Shandong province, 93% (64/69) was farmer. Penetrating keratoplasty (PKP) were performed for 63 cases with a transplantation of donor cornea > 8.0 mm. However, 6 eyes were enucleated because of the severe endophthalmitis. Most of patients sought medical care following a same procedure: village and towns medical service, county hospital, city medical center. The time interval between the first medical contact and presentation to our center was 22.9 days on average. 78% (54/69) patients attended to county hospitals, only 24% (13/54) patients got correct diagnosis of fungal keratitis. Smear examination had been undertaken only in 22% (12/54) of cases, the positive rate was 50%. In 30 patients who initially contact to city medical centers, 63% (19/30) was diagnosed as fungal keratitis, 73% (22/30) was given smear examination with positive result of 73% (16/22). The positive rate of corneal scraping for fungus was 93% (64/69). 46% (35/69) patients were prescribed antifungal agents of fluoconazole.


CONCLUSIONS
Several factors, including ignoring traumatic history and basic examination techniques, lacking of effective ophthalmic antifungal agents, cornea donor, without qualified ophthalmologists, lead to inappropriate management in fungal keratitis.
Li
Shao-wei
SW
Shandong Eye Institute and Hospital, Qingdao 266071, China. swli@qd-public.sd.cninfo.net
Xie
Li-xin
LX
Jin
Xiu-ming
XM
Shi
Wei-yun
WY
Zeng
Qing-yan
QY
D000293:Adolescent; D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies