The 40-year-old vegetable supplier was almost blind, not afraid of the “red code”, and the ENT hospital urgently completed the difficult corneal transplant

Recently, the Eye and ENT Hospital (Otolaryngology Hospital) Affiliated to Fudan University urgently completed the difficult corneal test for a patient with abnormal nucleic acid test results Transplant surgery to save the patient’s eyes.

Almost blind, nucleic acid abnormalities

The 40-year-old vegetable supplier unfortunately suffered from fungal corneal ulcers and was During the drug treatment stage, the house leaked during the night of rain, his nucleic acid test results were abnormal, and his condition worsened. Fungal corneal ulcer is very difficult to treat. When he was sent to the hospital by “120”, almost all of the cornea was clouded and turned into pus, and his vision was only faint.

Dangerous condition and many challenges

Professor Gong Lan, Director of the Department of Ophthalmic Surface Diseases, Department of Ophthalmology, Eye and ENT Hospital, Fudan University The team conducted an emergency consultation for the patient. Under the slit lamp, it could be seen that the corneal pus coating was covered and perforation had occurred.

Fungal inflammation is very difficult to deal with. Is the eye content enucleated? This means that the patient will immediately lose hope of regaining sight, the eyeball will be shrunk forever, and he can only install a prosthetic eye later.

Conjunctival flap coverage? This menacing disease may be difficult to control in time, and if it continues to spread, it will not even be able to keep the eyeball wall.

Is it an emergency corneal transplant? The difficulty is high and the risk is high, and where can I find fresh plants at this moment? !

Closely cooperate to restore light perception

Professor Gong Lan’s team, with the original intention of serving the patients wholeheartedly, works in the medical department, The infection management department, outpatient and emergency office, operating room, anesthesiology department, laboratory department, and ward nursing team, etc., will open a green channel to diagnose and treat this red code patient. In the negative pressure operating room, Professor Gong Lan carefully cleaned the pus and moss for the patient, calmly studied and judged the condition, and finally overcame the difficulties. The needle is sutured properly.

On the first day after the operation, although the corneal graft still had obvious edema, the patient’s vision had improved from low-light to manual operation, the inflammation was controlled, and the eye protection was initially successful!

Don’t be afraid of the red code, the patient comes first

President Zhou Xingtao of the Eye and ENT Hospital Affiliated to Fudan University said that Gong Lan The professor’s team put the patient first in emergency treatment, without hesitation or fear of the “red code”. This difficult penetrating keratoplasty is the first step in the entire treatment, and we will continue to overcome various postoperative complications. problem and hope that the patient will recover smoothly.

Eye, Nose and Throat Hospital will continue to persevere and do its best to fight the epidemic while providing medical services to ensure that patients receive timely diagnosis and treatment.

Fungal keratitis science

Fungal keratitis is an extremely dangerous corneal infection caused by yeast, mold and other eukaryotic organisms inflammation. It is dangerous because it is difficult to diagnose, difficult to treat and highly blinding.

The incidence of fungal keratitis is affected by climate, geography and occupation. In developing countries such as my country, more than 90% of patients have a history of plant or soil trauma. For example, in the vegetable supply occupation in this case, once corneal trauma occurs in the workplace, there is a greater risk of fungal infection. With the development of medicine, the long-term use of topical ocular antibiotics and hormones, and the irregular wearing of contact lenses have gradually become common risk factors in recent years.

The clinical diagnosis of fungal keratitis is very difficult. In the early stage of the disease, patients may only have a foreign body sensation in the eye accompanied by progressive eye pain as the initial symptoms, and the signs and symptoms are more similar to bacterial keratitis. In addition to relying on the rich experience of ophthalmologists for clinical diagnosis, it is very important to provide a history of trauma and to check and test as soon as possible.

Ophthalmologists usually scrape corneal lesions for smear examination and etiological culture, and confocal microscopy is also an important clinical tool. These tests can effectively help doctors identify different types of keratitis caused by bacteria or fungi.

The drug treatment of fungal keratitis is also a difficult point in clinical work. In addition to the commercially available ophthalmic antifungal drug “Natamycin”, the Eye and Ear Nose and Throat Hospital Affiliated to Fudan University can provide more effective treatment for patients. The hospital has prepared eye drops such as voriconazole and fluconazole to keep the light of many patients. offered a ray of hope. But for patients who are difficult to control with local drugs, surgery is the only way out.

Conjunctival flap occlusion or corneal transplantation are commonly used eye-preserving surgeries. Although corneal transplantation is of great help in improving the patient’s vision, it has extremely high technical requirements for the surgeon and is very difficult for the surgeon. The admission hospital also has requirements for the supply of corneal materials.

Therefore, for patients who cannot be controlled by drugs, have caused perforation, or even have an infection involving the entire eyeball, in order to prevent the infection from further affecting the surrounding tissues and even life, sometimes doctors will also perform eye content enucleation. excision. However, after the patient undergoes enucleation of the ocular contents, the possibility of restoring vision will be permanently lost, so it is the last choice of ophthalmologists. Fungal keratitis will be more difficult and challenging under the influence of the epidemic. As the only tertiary A-level specialized hospital in the country, every ophthalmologist in the Eye and Ear Nose and Throat Hospital Affiliated to Fudan University will do their best to keep fighting to protect every inch of the patient’s light.