Year : 1984 | Volume
: 32 | Issue : 5 | Page : 311--315
Mycotic keratitis in indian patients
Anita Panda, Madan Mohan, G Mukherjee
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIMS, Ansari Nagar, New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi
|How to cite this article:|
Panda A, Mohan M, Mukherjee G. Mycotic keratitis in indian patients.Indian J Ophthalmol 1984;32:311-315
|How to cite this URL:|
Panda A, Mohan M, Mukherjee G. Mycotic keratitis in indian patients. Indian J Ophthalmol [serial online] 1984 [cited 2021 Sep 18 ];32:311-315
Available from: https://www.ijo.in/text.asp?1984/32/5/311/27500
Various reports regarding microbiological study, medical treatment, surgical treatment and experimental aspects of the mycotic keratitis are seen in the literature.,,,,, Hardly any study is seen about their histopathological characters.
A study therefore has been conducted on corneal buttons with the clinical diagnosis of mycotic corneal ulcers to review the detail histopathological nature.
MATERIALS AND METHODS
A total of 140 corneal buttons diagnosed as mycotic keratitis histopatho logically during a period of 16 years were analysed. After fixation the sections were stained with haematoxylene and eosine, PAS and Gomeri silver methenamine. A thorough microscopical examination was carried out to study the detailed histopathological findings.
The aetiological distribution of the ulcer is shown in [Figure 1]. The status of the epithelium and Bowman's membrane is highlighted in [Table 1][Table 2] respectively. The site of the corneal involvement is shown in [Table 3] and [Figure 2]. [Table 4][Table 5] exhibit the depth of the corneal involvement and depth where the fungus could be identified [Figure 3][Figure 4][Figure 5][Figure 6]. The type and spread of the fungus is evident from [Table 6]. The type of infiltrative reactions is highlighted in [Table 7].
The normal cornea is remarkably resistant to mycotic infection. Inspite of its remarkable ability to repair itself after injury a large number of cases are seen suffering from keratomycosis. The reason being the negligence of the patient & improper management of the injury. The other reason of development of keratomycosis in cases where the fungus infection is superimposed on some other ocular disease is also inappropriate manage The effective treatment of a fungal corneal ulcer requires r arly diagnosis and vigorous therapy. As there is possibility ofgetting positive report from normal conjunctivalsacs and negative report from the face of active infection a scrapping from the junction of the ulcer and healthy cornea is ideal. The three buttons which showed presence of hyphae at epithelial level were not purely epithelial but seen only when there was deeper involvement and only in 2.14% of buttons. Therefore to diagnose mycotic -sub keratitis the superficial layer study is not at all adequate. The chances of contamination does not arise in cases where the diagnosis is histopathologically proved. The other important indication of histopathological study is to know the exact site of involvement, thus the graft prognosis can be given before hand.
Judging from the histopathological study one can anticipate invasion of the corneal stroma by the fungus for a considerable distance beyond the ulcer bed. In advanced cases, the fungus reaches the Descemet's membrane and extends to the periphery. In some cases it may penetrate the Descemet's membrane to enter the anterior chamber without producing clinical evidence of corneal perforation. Therefore one can very well plan the post-operative therapy in these cases. In this study 70% of eyes had deeper involvement. However, type of fungus does not alter the surgical treatment. Interestingly the buttons where the carpet lesions were seen, when assessed, almost all of them had poor nutritional status and low immunity for which supportive therapy was instituted, so it is evident that even if one does not know the general status of the patient it can be commented after noting this histopathological findings and the case can have the proper treatment.
Therefore the histopathological study of the corneal button is not only helpful for the local management of the case but also calls for systemic management.
It is a known fact that the fungal hyphae lie parallel to the corneal surface. As about 2/3rd of the cases showed vertically running down pattern it became quite interesting to know the reasons. Surprisingly it was noted that those showing vertically down running fungal hyphae, majority of them had preoperative local corticosteroid. However, this does not help us in future management
It is interesting to note the infiltrative reaction also. Presence of polymorphonuclear reaction in corneal stroma sugests bacterial and that of mononuclear reaction fungal involvement. In this present study even though the polymorpho reaction is mostly seen it is due to fungal rather than bacterial, as presence of micro-abscess is itself the diagnostic clue for fungal infection. Therefore whatever the number of polymorphonuclear reaction, in presence of multiple abscess formation the case is to be diagnosed as keratomycosis.
Environmental factor plays some role for the type of organisms. India being the hoter climate aspergillus infection is most commonly encountered. Next common was the candida which occurred mostly during warmer period such as rainy season.
SUMMARY AND CONCLUSION
Histopathological analysis of 140 mycotic corneal buttons has been carried out. Attention is drawn to the extent of invasion of the tissue and eventually of the prognosis. Several interesting conclusions are drawn:
1. Histopathological examination of the corneal buttons in cases where therapeutic keratovlasty was performed is important
2. The question of contamination does not arise as in case of cultures.
3. The exact depth of the involvement by the fungus can be known.
4. Immunity of the individual can be detected.
5. Graft prognosis could be anticipated.
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