Garg Prashant, Vemuganti Geeta K, Chatarjee Samrat, Gopinathan Usha, Rao Gullapalli N
Cornea Service, LV Prasad Eye Institute, Hyderabad, India.
Cornea. 2004 Aug;23(6):571-6. doi: 10.1097/01.ico.0000126318.90271.3c.
To evaluate the clinical, microbiologic, and histopathologic features of dematiaceous fungal keratitis cases presenting with pigmented, raised, plaque-like infiltrate.
Consecutive case series.
Microbiology-proven cases of fungal keratitis presenting with a pigmented infiltrate were included in the study. A detailed clinical and microbiological evaluation was performed in all cases. The lesion was removed by superficial keratectomy, and the specimen was subjected to histopathologic examination. Patients presenting with a large infiltrate had penetrating keratoplasty, and the corneal button was submitted for histopathology examination.
We enrolled 15 cases in the study. There were 11 men and 4 women. The mean age of the patients was 48.5 years (range 27-68 years). The patients presented to us with duration of symptoms ranging from 7 to 60 days (mean 27.6 +/- 15.6, median 30). The visual acuity was better than 20/200 in 9 (60%) cases. The infiltrate size varied from 4.3 to 64 mm2 (mean 26.9 +/- 16.6, median 22.5). Ten (66.7%) cases had a central infiltrate. The infiltrate was dry and raised, with brown to black pigmentation on its surface. Corneal scrapings revealed septate fungal filaments in all cases and the characteristic brown to black pigmentation of the fungal cell wall in 10 (66.7%) cases. Although there was a significant growth of dematiaceous fungi on culture in all cases, species identification could be done in 3 cases only. Examination of tissue sections revealed a carpet of pigmented fungal filaments on the corneal surface (n = 12, 92.3%) associated with mild to moderate inflammation (n = 11, 84.7%) and tissue destruction. Nine out of 11 cases that had keratectomy resolved with medical therapy.
The pigmented plaque-like infiltrate in dematiaceous fungal keratitis consists of surface colonization of pigmented fungal filaments associated with mild to moderate inflammation and tissue destruction of the underlying corneal stroma.
评估呈现色素沉着、隆起、斑块状浸润的暗色真菌性角膜炎病例的临床、微生物学及组织病理学特征。
连续病例系列研究。
纳入微生物学证实的伴有色素沉着浸润的真菌性角膜炎病例。对所有病例进行详细的临床和微生物学评估。通过浅层角膜切除术切除病变组织，并将标本进行组织病理学检查。浸润范围较大的患者接受穿透性角膜移植术，取下的角膜植片进行组织病理学检查。
本研究共纳入15例患者。其中男性11例，女性4例。患者的平均年龄为48.5岁（范围27 - 68岁）。患者出现症状的时长为7至60天（平均27.6 ± 15.6天，中位数30天）。9例（60%）患者的视力优于20/200。浸润面积从4.3至64平方毫米不等（平均26.9 ± 16.6平方毫米，中位数22.5平方毫米）。10例（66.7%）患者的浸润位于中央。浸润干燥且隆起，表面有棕色至黑色色素沉着。所有病例的角膜刮片均显示有分隔的真菌丝，10例（66.7%）病例的真菌细胞壁呈现特征性的棕色至黑色色素沉着。尽管所有病例在培养时暗色真菌均有显著生长，但仅3例能够进行菌种鉴定。组织切片检查显示角膜表面有一层色素沉着的真菌丝（n = 12，92.3%），伴有轻度至中度炎症（n = 11，84.7%）及组织破坏。11例行角膜切除术的患者中有9例经药物治疗后痊愈。
暗色真菌性角膜炎中的色素沉着斑块状浸润由色素沉着真菌丝的表面定植组成，伴有轻度至中度炎症以及下方角膜基质的组织破坏。
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