title: Excisional keratectomy combined with focal cryotherapy and amniotic membrane inlay for recalcitrant filamentary fungal keratitis: A retrospective comparative clinical data analysis.
abstract: The aim of the present study was to investigate the efficacy of a novel surgical intervention, excisional keratectomy combined with focal cryotherapy and amniotic membrane inlay (EKCAI), for the treatment of recalcitrant filamentary fungal keratitis. A retrospective analysis was performed of patients who underwent excisional keratectomy combined with conjunctival flap inlay (EKCFI), EKCAI or therapeutic penetrating keratoplasty (TPK) from January 2006 to January 2011. Recalcitrance was determined as being unresponsive to standard medical antifungal therapy for at ≥1 week. Outcome measures among the three intervention modalities were compared. A total of 128 patients had a follow-up of ≥1 year after the primary intervention. The success rates of interventions at 1-year follow-up were 58.33% in the EKCFI group, 88.37% in the EKCAI group and 93.44% in the TPK group (P<0.0002). The preoperative visual acuity of the three groups were similar (P=0.6458), while the postoperative best-corrected visual acuity (BCVA) of patients without recurrence was significantly different among the three groups 3 months after surgery. The best postoperative BCVA was found in the TPK group, while the worst was in the EKCFI group. In conclusion, EKCAI does not require donor cornea, is straightforward surgically, and has a favorable success rate compared with EKCFI.
authors.affiliation: Department of Ophthalmology, The General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, P.R. China.
authors.forename: Yingxin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, The General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, P.R. China.
authors.forename: Minghong
authors.initials: M
authors.lastname: Gao
authors.affiliation: Department of Ophthalmology and Visual Science, College of Medicine, The University of Arizona, Tucson, AZ 85711, USA.
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Duncan
authors.affiliation: Epidemiology and Biostatistics Division, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA.
authors.forename: Di
authors.initials: D
authors.lastname: Ran
authors.affiliation: Epidemiology and Biostatistics Division, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Roe
authors.affiliation: Department of Ophthalmology and Visual Science, College of Medicine, The University of Arizona, Tucson, AZ 85711, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Belin
authors.affiliation: Department of Ophthalmology and Visual Science, College of Medicine, The University of Arizona, Tucson, AZ 85711, USA.
authors.forename: Mingwu
authors.initials: M
authors.lastname: Wang
keywords: amniotic membrane inlay; conjunctival flap; cryotherapy; refractory fungal keratitis; therapeutic keratoplasty