Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
PLoS One. 2012;7(8):e42126. doi: 10.1371/journal.pone.0042126. Epub 2012 Aug 24.
To evaluate the treatment outcomes and costs of early keratectomy in the management of moderate Fusarium keratitis.
METHODOLOGY/PRINCIPAL FINDINGS: Consecutive cases of culture proven Fusarium keratitis treated at our hospital between January 2004 to December 2010 were included in this retrospective study. There were 38 cases of moderate keratitis with infiltrates between 3 to 6 mm in diameter and depth of infiltration not exceeding the inner 1/3 of the cornea. After excluding 5 patients with incomplete follow-up data, 13 patients who received early keratectomy within 1 week of admission were compared with a group of 20 patients treated medically. The significance of the association between early keratectomy and visual acuity, progression to perforation, secondary glaucoma and cataract formation, adjuvant therapy, hospitalization days and cost were assessed. There were no differences between the keratectomy and medication groups in regards to age, sex, presence of systemic diseases, and hypopyon formation on presentation. The early keratectomy group had a shorter hospital stay than the medical therapy group. Disease duration was significantly lower in the early keratectomy group (median: 29.0 vs. 54.5 days, P<0.001). Median hospitalization costs per patient were lower with early keratectomy (mean ward fee: 15175.4 vs. 44159.5 NTD, P<0.001; mean donor fee: 0 vs. 900.0 NTD, P<0.001), primarily because of reductions in hospital stay. More patients in the medication group developed perforations than in the keratectomy group (20% vs. 0%, respectively) and the perforation-free rate was higher in those with early keratectomy, but the results were not statistically significant.
CONCLUSIONS/SIGNIFICANCE: Early keratectomy in moderate Fusarium keratitis may reduce length of hospital stay, hospital costs, and perforation rates.
评估早期角膜切除术治疗中度镰刀菌角膜炎的治疗效果和成本。
方法/主要发现：本回顾性研究纳入了 2004 年 1 月至 2010 年 12 月期间在我院接受治疗的经培养证实的镰刀菌角膜炎连续病例。其中 38 例中度角膜炎，浸润直径 3 至 6 毫米，浸润深度不超过角膜内 1/3。排除 5 例随访资料不完整的患者后，将 13 例在入院后 1 周内接受早期角膜切除术的患者与 20 例接受药物治疗的患者进行比较。评估早期角膜切除术与视力、穿孔进展、继发性青光眼和白内障形成、辅助治疗、住院天数和成本之间的关联的显著性。角膜切除术组和药物治疗组在年龄、性别、是否存在全身性疾病以及就诊时有无前房积脓方面无差异。角膜切除术组的住院时间短于药物治疗组。角膜切除术组的疾病持续时间明显短于药物治疗组（中位数：29.0 与 54.5 天，P<0.001）。早期角膜切除术患者的人均住院费用较低（平均病房费用：15175.4 与 44159.5 新台币，P<0.001；平均供体费用：0 与 900.0 新台币，P<0.001），主要是因为住院时间缩短。药物治疗组中有更多的患者发生穿孔，而角膜切除术组则没有（分别为 20%和 0%），并且早期角膜切除术的穿孔无率更高，但结果无统计学意义。
结论/意义：早期角膜切除术治疗中度镰刀菌角膜炎可能会缩短住院时间、住院费用和穿孔率。
