NEW APPROACHES OF CURATIVE AND OPTIC INDICATIONS IN TH TREATMENT OF INFECTIOUS CORNEAL ULCERS
A.A. Bialasiewicz, A. Hassenstein, A. Assadoullina, K. Engelmann, G. Richard
Treatment protocols of infectious keratitis with or without perforation remain controversial. Medical and insufficient long-term treatment and delayed surgical interventions may result in severe complications. New and flexible treatment strategies have made possible an immediate curative effect and optic rehabilitation, and have diminished the time of hospitalization. We report on the differential approaches and the treatment results of combined procedures A chaud in eyes suffering from infectious keratitis.
Patients: Triple procedures A chaud were performed on 66 eyes of 130 (125 patients) in 1994-1997. Diagnosis: serpent ulcer: 22x, akanthameba keratitis: 7x, HSV and VZV perforation: 11x, rheumatoid arthritis: 11, lagophthalmus: 5x, lye burn: 4x, trauma: 2x, OCP: 3x, SJS: 1x. OP: mini-graft: 5x, sklerocorneal graft: 6x, sulcusfixated IOL: 5x.
Results: serpent ulcer: local antibiotics ofloxacin, systemic antibiotics: ciprofloxacin and carbapenem, surgery without delay and intraoperative definition of the entry of infection, trephination accordingly and consideration of optic conditions, AC reconstruction, ecce and IOL in complicated cataracts or in case of persisting athalamy, iridectomy, application of i.o. Cefotiam and rTPA, systemic application of >120mg methylprednisolone. Follow-up: 6 months-4 yrs, median 2N yrs. On average, the 22 eyes with most severe serpent ulcers presented quiet after 1 N days, increase in VA in each case, hospitalization 9 days (4-20 days).
Complications: fibrin 1x, graft rejection 1x, chronification/ reactivation of pathogens: 0x, secondary glaucomas: 0x.
Conclusions: Flexible indications concerning surgical procedures and application of new and effective medications for antiinfective and antiinflammatory treatment are significant milestones in the fast curative and optic rehabiliation of patients with most severe infectious keratitis.
Supported by Deutscher Akademischer Austauschdienst A/96/28745
University Eye Hospital Eppendorf, Martinistr. 52, D-20246 Hamburg