Cornea - I Free Papers - aioseducation

69th AIOC Proceedings, Ahmedabad 2011
It penetrates the cornea poorly and acts only on superficial keratitis. It is
expensive and requires frequent instillation. It is mostly available in 3ml glass
packing which leak many a times. Amphoterecin B for topical application
is not available off the shelf and has to be prepared fresh. It is available as
injection and as such its penetration of intact epithelium is poor.
The population at risk is located far from tertiary care centers and detailed
microbiological assessment at grass roots level is difficult. So to cut ice the
protocol of management of fungal ulcers should be simple, reproducible and
inexpensive.
The first step in the management of most corneal ulcer is scraping. Standard
scraping encompasses removal of the epithelium with necrotic tissue at the
ulcer and its bed. This decreases load of the organism and improves penetration
and availability of the antifungal agent. Simultaneously scraping acts as a
diagnostic tool in the form of KOH mount preparation to diagnose fungal
filament etc. 10% KOH mount is inexpensive and easy; it requires minimum
infrastructure and results are obtained immediately. A trained technician can
do it. But an ophthalmologist executing the whole exercise himself or herself
increases the yield of the organism. Chances of isolating fungal filaments in
corneal scraping is as high as 90 to 99%, Vis-à-vis 88.75% by Gramstain.
The diagnostic and therapeutic scraping that is practised by most removes the
necrotic tissue but the heavily infiltrated pre necrotic tissue at the ulcer bed is
left behind. This study focuses on a method of deeper scraping whereby this
prenecrotic tissue with its load of infiltration and cytokines is removed to a
great extent. This method is destined to promote better drug availability and
thus quicker healing and lesser scarring.
MATERIALS AND METHODS
It is a predesigned prospective interventional case series of consecutive 153
cases of fungal keratitis with filaments demonstrated in 10% KOH at Disha
Eye Hospital (Hooghly) during January 2008 and December 2009
Patient
All patients with red eye who report to the OPD of the tertiary care eye centre
Disha Eye Hospital (Hooghly) are screened for corneal ulcer. This tertiary care
hospital serves semi urban and rural people of Howrah,Hooghly and Burdwan
districts of West Bengal. The livelihood of majority of patients turning up to
the OPD of this hospital is agriculture based.
Ulcer
Ulcer is defined as breech in corneal epithelium with infiltration of underlying
stroma, with or without hypopyon.
472