|Year : 1983 | Volume
| Issue : 5 | Page : 692-697
Various tactors in etiopathogenesisof galloping cornealulcer and their response to therapy
Kamlesh, V Behari, D Srivastava
State Institute of Ophthalmology at M.D. Eye Hospital, Allahabad, India
State Institute of Ophthalmology at M.D. Eye Hospital, Allahabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kamlesh, Behari V, Srivastava D. Various tactors in etiopathogenesisof galloping cornealulcer and their response to therapy. Indian J Ophthalmol 1983;31:692-7
|How to cite this URL:|
Kamlesh, Behari V, Srivastava D. Various tactors in etiopathogenesisof galloping cornealulcer and their response to therapy. Indian J Ophthalmol [serial online] 1983 [cited 2019 Oct 20];31:692-7. Available from: http://www.ijo.in/text.asp?1983/31/5/692/36635
Among ocular diseases, Corneal Ulcer constitutes a major cause of blindness in India, though experiments have been carried out from time to time to find out the cause of rapid progression of ulcers and their resistance to even best therapy of modern age, yet very few studies point out towards the etiopathological factors of galloping corneal ulcers.
Therefore this work has been planned to report the various etiopathological factors leading to the development of galloping corneal ulcer as well as their extent of response to most suitable and best available modern therapy, so that one could prevent the dreaded sequales of corneal ulcer as well as their occurence.
This work also signifies the role and reliability of KOH, gram's and Geimsa stainings in detection of fungal myecilium in corneal scrappings and blood-group relation with corneal ulcer. The selection have been made upon following criteria for the galloping corneal ulcer cases:
1. Rapid increase in size of corneal ulcer.
2. Hardly any response to treatment.
3. Most of corneal tissues are eaten, up during the course of ulceration.
4. Sloughing corneal ulcer of various variety along with hypopyon.
5. Small superficial ulcers which suddenly flare up.
6. The ulcers threatening to perforation.
| Material and Method|| |
The study was conducted on 69 patients. Thorough and detailed history of illness as well as general, systemic and local examinations were done. Routine investigations like blood, urine, stool and conjunctival smear examination for puscells and fungal hyphae under 20% KOH, Gram's and Geimsa staining were done. The culture and sensitivity test for bacteria were done on blood agar and MacConkey media by taking smear from ulcer floor. Sabrauds media was used for fungal culture. Further their identification were done by specific biochemical reactions. The other special investigations done are fasting blood sugar, post parandial sugar, VDRL, Serum Protein, Serum Cholesterol, blood grouping, X-ray Chest and montoux test (in suspected cases of tubercular lesion). The sensitive tests for bacteria have been done against peniciiline, streptomycin, chloramphenicol, tetracycline, Gentamycin, Bactrim, Kanamycin, Klox and Ampiclllin. Two types of antifungal ointment fungizone (Amphotericin B+Neomycin) and Nystatin 1 % ointment were used. One of them were tried for 5 days and if responded it continued till healing otherwise switch over the other and vice-versa in pure fungal cases and along with sensitive drugs in mixed cases. The surgical manuvers taken were cauterization with carbolic or cryo, paracentesis, conjunctival flapping, tarsorraphy and dacryocystorhinostomy.
The improvement was indicated in the form of relief of symptoms, extent of ulcer and vascularization, clearing of corneal oedema, control of discharge, decrease in ciliary congestion, reduction in cell and flare in A.C. wide dilated pupil and improvement in visual acuity.
| Observation and Discussion|| |
For the purpose of description the patients are devided into four groups as follows:--Bacterial, Fungal, Mixed (Bact + Fungal) and Sterile.
In no case KOH test was positive with a negative gram's and Geimsa staining.
The patients of total monthly income of Rs. 150 or below were of low group while patients of middle and high group had income of 150 to 800 and Rs. 800 or above (W.H.O. classification).
All the 6 cases showed poor response to therapy.
Role of Socio-Economic and Nutritional Status
In our whole series, 74% cases came from rural areas and rest 26% from urban areas. The low virulent-organism e.g. staph. Albus and staph. aureus were commonest organisms found in low socio-economic group and pseudomonas and staph aureus in higher and middle groups.
The protein plays a vital role in quick healing of ulcers as observed by us. The number of cases and time taken for healing were more in vegetarian (72.5%) as compared to non-vegitarian (7.2%). 52% people were getting protein less than 30 gm% with lack of first class protein. 72.5% cases have serum protein level below 7 gm%. Further we found that the healing of ulcer is parallel to general health and haemoglobin percentage.
Response to Therapy
In bacterial group out of 16 cases in which out of 16 cases, 12 the bacteria were sensitive in 12 cases 2 Klox. There was hardly any role of surgical interference in these type of ulcers. 18 out of 21 were cured by giving routine treatment, supportive and or additional treatment along with high protein diet. The optimum time taken in superfecial cases was 2 to 3 were and 3 to 4 weeks for deep cases.
In fungal group the fungi isolated were Aspergillus in 10 (14.5%) and candida in 5 (7.25%) cases. 3 cases (4.35%) cured with fungizone only and 5 (7.25%) along with additional treatment. Mycostatin ointment was proved in curing 3 cases with additional as well as one with aid of surgical treatment. In mixed group out of 9 cases, 4 ulcers perforated in spite of best medication and doing necessary surgical interference.
In sterile group 15 (21.98%) cases responded to routine treatment supportive and/or additional treatment, 5 cases responded only after doing some of surgical procedures i.e. paracentesis and tarsorrhaphy.
| Summary|| |
Incidence of galloping corneal ulcer was more common in male and between age group of 26-45 years. These cases mainly came from rural areas and belonged to low socio-economic group. Staphylococcus aureus and Aspergillus were the commonest organisms isolated and mixed ulcers showed more resistance. The resistant bacteria mostly seen sensitive to Klox. The trauma (46.4%), conjunctivitis (17.4%) and keratomalacia (11.60%) were the common predisposing factors and above all the illeteracy. So health education is very important especially for urban people. Diminished sensations, blocked nasolacrimal passage and raised tension were the causes which delay the healing of ulcer. It is important to exclude above factors before deciding the surgical procedure. So, for the quick healing of ulcer general health should be improved and diet rich in protein and other components together is required and one single factor such as vitamin-A, only protein, B. Complex, Vitamin-C, separately is not responsible for good healing of ulcer as has been talked by various workers. We found that individual of blood group B (+) ive were more prone to develop the galloping corneal ulcer.
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9], [Table - 10], [Table - 11], [Table - 12], [Table - 13], [Table - 14], [Table - 15]