Ah, the time old conflict of a surgeon and a medical doctor. Do we treat an ailment with drugs or scalpels? If we choose drugs, are we just culling the weak and leaving the strong pathogens? If we choose to operate, are we putting patients through excessive procedures and how do we know we have gotten everything?
One of the recent battles in this war was fought over moderate cases of Fusarium keratitis by researchers at the Chang Gung University College of Medicine (CCUCM).
|Progress of Fusarium keratitis|
The researchers investigated 38 cases of moderate Fusarium keratitis between January 2004 and December 2010. Of those patients 13 got keratectomies within a week of entering the hospital and twenty were only treated medically. Out of the patients, five of them didn’t have follow up records and were thus discarded from the research conclusions. There were no major differences between these two groups in regards to age, sex, or severity of eye infection; however it was noted that the medicated group did average a significantly worse baseline vision than the surgery group.
While reviewing all records the group contrasted costs, hospitalization days, disease duration, and perforation progress between the contrasting treatments. Eye photographs were documented weekly and any progress or negative response led to a reculture for Fusarium after a 24 hour break of topical antibiotics.
The results seem to be a straight up win for the surgeons. The group receiving keratectomies had a much shorter duration of the disease, with an average of 29 days vs. 54 days; and of those days the surgery group was only in the hospital 11 days, compared to the medical groups average 31 day stay. Of course the longer stay for those receiving medication also caused a severe jump in cost, having a range centering around 20,000 New Taiwan Dollars higher. And addressing the largest physical end comparison, the degree of corneal perforation following the procedures: in this study group 20% of those treated with medicine only developed perforations, while absolutely none of the patients that went through surgery did. The Scalpel jockeys seem to have sliced out a victory here.
That being said the research team did acknowledge that this was just a retrospective study and with treatments based on the preferences of the physicians, which allowed for potential biases.
Now for the real purpose of this post:
Hsin-Chiung Lin, Ja-Liang Lin, Dan-Tzu Lin-Tan, Hui-Kang Ma, & Hung-Chi Chen (2012). Early Keratectomy in the Treatment of Moderate Fusarium Keratitis PLOS One DOI: 10.1371/journal.pone.0042126