The effectiveness of electrosurgical treatment of drug-resistant keratitis

Abstract

Purpose. To evaluate the effectiveness and safety of direct current cornea fulguration in the treatment of drug-resistant keratitis. Material and methods. 20 patients (20 eyes) diagnosed with drug-resistant infectious keratitis (bacterial, acanthamoeba, fungal), underwent fulguration of the infiltration zone with plasma electrocautery. In addition to a standard ophthalmological examination, all patients were tested for corneal thickness and lesion depth before surgery and 1 day, 1 month, and 3 months after surgery by anterior segment optical coherence tomography (OCT). After photofixation of the cornea, OCT data were used to dynamically assess the lesion area and deepithelialization. Results. In 95 % of cases (19 eyes), the infectious inflammatory process could be stopped in 3 to 7 weeks, with the opacification onset in the stromal layers of the cornea 2–3 weeks after the procedure. In these cases, after 2 weeks, the infiltrated or corneal ulcer area was completely epithelialized. Over a long postprocedural period (3 months), the corneal thickness in the inflammation area varied from 285 µm to 791 µm. During the entire observation period, the integrity of the cornea was maintained and transparency improved. 3 months after surgery, the average visual acuity corrected by spectacle lenses increased from 0.42 ± 0.35 to 0.54 ± 0.33. Conclusion. Direct current fulguration can be an effective and relatively safe urgent treatment for drug-resistant infectious keratitis.

Keywords

• electrosurgery
• fulguration
• crosslinking
• infiltrate
• drug-resistant infectious keratitis
• corneal ulcer