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ORIGINAL ARTICLE
Year : 1983  |  Volume : 31  |  Issue : 4  |  Page : 391-393
 

Treatment of mycotic sloughing corneal ulcer by actual cautery-a review of 110 cases


Gandhi Eye Hospital, Aligarh, India

Correspondence Address:
U S Srivastava
Gandhi eye Hospital Aligarh (U.P.)
India
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PMID: 6677596

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How to cite this article:
Srivastava U S, Jain A K, Singh V P. Treatment of mycotic sloughing corneal ulcer by actual cautery-a review of 110 cases. Indian J Ophthalmol 1983;31:391-3

How to cite this URL:
Srivastava U S, Jain A K, Singh V P. Treatment of mycotic sloughing corneal ulcer by actual cautery-a review of 110 cases. Indian J Ophthalmol [serial online] 1983 [cited 2014 Nov 1];31:391-3. Available from: http://www.ijo.in/text.asp?1983/31/4/391/27562


Indiscriminate topical use of antibiotics espicially tetracycline and steriods has effec­ted the normal symbiosis between the bacteria and fungi. The suppression of bacterial growth encourages proliferation of the fungi.[1],[2]

In selecting our cases for this study follo­wing clinical criteria were used to diagnose mycotic sloughing corneal ulcer.

The eye was comparatively quiet, looking to the extent of ulcer and hypopyon. There were few symptoms. The corneal lesion was dry, granular and slightly raised. There was often a yellow line of demarcation limiting the lesion. Some times small well defined greyish white infiltrates were present in the stroma. The vascularisation was minimal.


  Materials and methods Top


110 consecutive cases conforming to the above mentioned clinical criteria were inclu­ded in this series. They were divided into two groups depending upon the size and depth of the lesion.

Group A : 43 cases-corneal lesion of more than 5mm in diameter and involving deeper layers of corneal stroma.

Group B : 67 cases-corneal lesion of less than 5mm in diameter and involving only superficial layers of corneal stroma.


  Treatment Top


The secondary infection, if any, was eradi­cated by the use of intensive topical antibio­tic applications. Atropine was instilled to dilate tye pupil and general condition of the patient was attended to. Anaesthesia : Orbicularis oculi akinesia was produced by 3.5cc of 2% Ligonocaine using O'Brien's method and topical anaesthesia was produced by 4% Lignocaine.

Actual Cautery : The slough was thoroughly dried with the help of cotton wool wicks. Actual cautery was performed by touching the head of a lightly heated common pin to the slough. The cauterisation was done from periphery towards the centre. Usually the coagulated slough formed a dense tissue.[3] sub This was lifted easily from the base of the ulcer with the help of an iris repositor leaving a clear ulcer base [Figure - 1][Figure - 2]. Care was taken not to injure the healthy corneal tissue by the cautery head.

Atropine oint. and Sulpha oint. were ins­tilled and a pad and bandage given.

The first dressing was done on the 3rd day when appreciable reduction in the size of hypopyon was noticed. In cases where ade­quate cauterisation was not possible, for fear of perforation, the process was repeated till desired results were obtained. The hypopyon disappeared completely within 4-10 days depending upon its original size. Complete healing took a further 10-15days.


  Observation Top


Out of the total of 110 cases only 23 cases failed to respond. All of them belonged to group A. These eyes were ultimately lost. All the 67 cases belonging to group B respon­ded.


  Discussions Top


The offending organisms in mycotic sloughing ulcers are entangled in the necrotic tissue. This makes them inaccessible to the topical chemotherapeutic agents.

Before the advent of fungicidal agents the classical method to treat the mycotic ulcers was to remove the sequestrum with a knife and to do galvanocautery at the ulcer base. As topical ocular fungicides and fungistatics are still not readily available in most of the places in our country, we resorted to the older method but with a difference. In our cases, instead of removal of sequestrum with the knife it was destroyed with the help of actual cautery. This helped in heat destruction of organisms and also making the ulcer bed accessible to the action of topical drugs.

Following advantages were noted when actual cautery was used as a part of treat­ment of mycotic sloughing corneal ulcers

1) Quick recovery

2) Shorter stay in the hospital

3) Comparatively thin resultant corneal

opacity

4) Better visual acuity

5) Better cosmetic appearance.


  Summary Top


110 cases of clinically diagnosed mycotic sloughing corneal ulcer were treated by actual cautery. Only 23 cases did not respond and led to loss of eye. The advantages of actual cautery have been enumerated.

 
  References Top

1.Roberts Shaler S., 1957, Amer J. Ophthalmol. 44:108.  Back to cited text no. 1    
2.Anderson et al : , 1959, Arch. Ophthalmol. (Chicago), 61:169  Back to cited text no. 2    
3.Srivastava U.S., 1974, Proc U.P. Ophthalmol Soc.  Back to cited text no. 3    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

    Tables

[Table - 1], [Table - 2], [Table - 3]



 

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