To investigate the clinical characteristics and treatment outcomes of fungal keratitis caused by Beauveria bassiana. The clinical data of 11 consecutive patients with fungal keratitis caused by Beauveria bassiana in the Eye Hospital of Shandong First Medical University from January 2019 to May 2024 were retrospectively analyzed. The clinical features, etiological characteristics, treatments and outcomes were analyzed. Most patients were farmers (10/11), with three cases caused by plant trauma and five cases having a history of corneal transplantation. Slit-lamp examination revealed that the keratopathy was characterized by dry ulcerative lesions, predominantly circular with relatively irregular borders. Several cases exhibited typical keratopathy signs of fungal keratitis, such as mycelial mat, pseudopodia and hypopyon. No significant immune ring structure was observed in any patients. Both the corneal scraping and in vivo confocal microscopy (IVCM) revealed branched and septate hyphae structures. Morphological and ITS sequencing identification was performed after isolation and cultivation. B. bassiana exhibited typical morphological characteristics: hyphae were branched, septate, transparent and slender; sympodial development of conidia was on a geniculate or zig-zag pattern; conidiogenous cells were flask-shaped, rachiform and sympodially proliferating, often aggregating into sporodochia or synnemata; conidia were hyaline and globose or ovoid in shape. B. bassiana had a relatively high susceptibility to the majority of antifungal agents in vitro. One patient was treated with medical therapy alone. The five patients with a history of corneal transplantation underwent penetrating keratoplasty (PKP). The two patients with ulcer depth < 1/2 corneal thickness and ulcer diameter ≤ 3 mm underwent corneal ulcer debridement combined with medical treatment. The three patients with ulcer depth exceeding 1/2 corneal thickness underwent PKP. Following treatment, no patient experienced recurrence during the follow-up period. Plant trauma, immunosuppression and involvement in agricultural production have been identified as significant risk factors for B. bassiana keratitis. Although the strains exhibited low minimal inhibitory concentrations (MICs) to most antifungal agents in vitro, early diagnosis and treatment remain crucial.

To characterize the clinical features and therapeutic outcomes of fungal keratitis caused by Plectosphaerella cucumerina. A retrospective analysis was conducted on 13 patients diagnosed with P. cucumerina keratitis from July 2018 to April 2024. Clinical manifestations, microbiological identification, antifungal susceptibility profiles, treatment regimens, and prognostic indicators were evaluated. All the 13 patients were farmers, and 6 of them had a history of trauma or the presence of a foreign body prior to the onset of symptoms. The main clinical manifestations were chronic progressive shallow corneal and middle stromal layer ulceration with dry ulcer surface, and moss formation was visible in 7 patients (7/13). No obvious immune ring structure and satellite lesions were observed in all patients. In vivo confocal microscopy (IVCM) showed that the mycelia showed medium strong reflection, some of them were changed like bamboo joints, most of them were 2–3 μm in diameter, and the arrangement was relatively neat and fasciculate. The Angle between the mycelia was small and most of them were acute angles. Drug sensitivity test showed that Amphotericin B, voriconazole and itraconazole were the main sensitive antifungal drugs. The main treatment was sensitive antifungal drugs combined with local lesion resection and voriconazole matrix injection. 2 cases with deep ulcers were treated with corneal transplantation. P. cucumerina keratitis is relatively rare but distinct clinical entity. Diagnosis can be aided by corneal scraping, microbiological culture and IVCM. Emphasizing a comprehensive treatment approach involving medication, debridement, and surgical intervention is crucial to promote rapid healing of the ulcer.

To compare the outcomes of corneal collagen cross-linking combined with lamellar keratoplasty (CXL-LK) versus LK alone in treating medically unresponsive acanthamoeba keratitis (AK). This retrospective, non-randomized controlled clinical study included 11 eyes (CXL-LK group) and 16 eyes (LK group) at a tertiary ophthalmology center. Corneal infiltration, density of acanthamoeba cysts (AC) and pathological changes following CXL in AK patients were assessed. One-year post-operation, refractive outcomes, graft survival, corneal endothelial loss rates and AK recurrence were evaluated. The area and depth of the infiltrates were reduced following CXL in AK patients, and the density of the AC decreased. Histopathological results indicated a reduction in AC volume after CXL, with the contents appearing wrinkled and degraded. At one year postoperatively, the corneal endothelial loss rate was 10.12

患者男,31 岁,因 "发现左眼视野缺损,视力下降 1 月余"入院.专科查体:矫正视力:R 0.8, L 指数/10 cm.眼压:R 14 mm Hg,L 45 mm Hg (未用降眼压药物).左眼:玻璃体鼻侧周边部可见色素颗粒,视盘边界清,色淡,C∶D≈0.8 ,黄斑中心凹反光欠清,鼻侧视网膜浅脱离,约 10 点位周边视网膜可见囊样变性区,未见明显裂孔.左眼超声示视网膜脱离,见图 1.

患者，女，52岁。因发现右眼上睑皮肤红肿20 d，于2022年5月就诊于山东第一医科大学附属眼科医院。患者20 d前无明显诱因出现右眼上睑皮肤红肿，就诊于外院，诊断为睑板腺囊肿，给予妥布霉素地塞米松眼膏治疗，未见明显好转。患者有甲减病史10余年，否认重大全身性疾病，否认药物过敏史，否认家族性遗传病史。眼部检查：右眼最佳矫正视力1.0，眼压11 mmHg（1 mmHg=0.133 kPa），右眼上睑近中央睑缘处见一直径约5 mm半球形隆起（图1A），质韧，局部皮肤稍有淤青、淤血，压痛阴性，结膜无明显充血，角膜透明，前房中等深浅，瞳孔圆，晶状体透明；左眼检查未见明显阳性体征。血常规、C反应蛋白、尿常规、即刻血糖、凝血功能、乙型肝炎病毒、丙型肝炎病毒、梅毒螺旋体、人类免疫缺陷病毒检查均正常。临床诊断：右眼眼睑肿物、右眼睑板腺囊肿？完善术前相关检查，患者于2022年6月8日在局部浸润麻醉下行"右眼眼睑肿物切除术"，术中平行睑缘切开肿物表层的眼睑组织，分离周围组织充分暴露肿物，剥离过程中见肿物内有大量白色干酪样及肉芽组织状内容物流出，剪除囊壁及肉芽，压迫止血。术后结膜囊及切口处涂氧氟沙星眼膏1次/d，左氧氟沙星滴眼液4次/d，持续1周。病理检查：送检囊壁组织约6 mm×3 mm×2 mm，灰白色，质地中等，主要成分为增生的纤维结缔组织伴慢性炎细胞浸润；内容物约5 mm×3 mm×2 mm，黄白色，呈颗粒状，主要由蓝染的嗜碱性细胞和嗜酸性的影细胞组成（图1B），病理学诊断：右眼睑钙化上皮瘤。术后右眼上睑切口对合好，无渗血、渗液，上眼睑无明显红肿。患者随访3个月，未见肿物复发。

Objective:The aim of this study was to investigate the etiological spectrum of infectious endophthalmitis and analyze the drug susceptibility characteristics of etiological organism in Shandong Province.Methods:A total of 350 patients (350 eyes) were collected from Eye Hospital of Shandong First Medical University (Shandong Eye Hospital) from 2013 to 2020 who were clinically diagnosed with suspected infectious endophthalmitis and received aqueous fluid and (or) vitreous samples for smear test, bacterial culture and fungal culture before examination and retrospectively analyzed. Isolated bacteria and candida were identified and drug sensitive test by Vitek 2 Compact automatic microbiological analysis system. The drug sensitivity data were analyzed by WHONET5.6 and expressed as cases and percentage.Results:Among 350 cases of suspected infectious endophthalmitis, there were 317 cases with exogenous endophthalmitis and 33 cases with endogenous endophthalmitis, accounting for 90.6% and 9.4%, respectively. There were 269 cases with both aqueous humor and vitreous fluid collected, 81 cases with aqueous humor collected. There were 67 cases with Gram-positive cocci, 8 cases with gram-negative bacteria, 8 cases with Gram-positive bacilli and 16 cases with fungi detected by smear, accounting for 28.3%, 67.7%, 8.1%, 8.1% and 16.1%, respectively. For culture in vitro, 135 cases were positive, a positive rate of 38.6%. There were 144 strains of isolated pathogenic organism, including 87 cases with Gram-positive cocci, 12 cases with Gram-positive bacilli, 15 cases with Gram-negative bacilli, and 30 cases with fungi, accounting for 60.4%, 8.3%, 10.5% and 20.8%, respectively. According to intraocular fluid smear and (or) culture positive as the gold standard for the diagnosis of infectious endophthalmitis, there were 211 patients of them with positive intraocular fluid smear and (or) in vitro culture, who were finally diagnosed as infectious endophthalmitis, an positive rate of 60.3%. Among of pathogens, Staphylococcus with negative coagulase was the top1, followed by Streptococcus. The main fungi were Fusarium and Aspergillus. The sensitivity of the isolated strains to levofloxacin ranged from 39.3% to 84.6%, which was higher than that of other drugs.Conclusions:From 2013 to 2020, the ocular trauma was the main pathogenic factor of infectious endophthalmitis in Shandong. Gram-positive coccus, especially Staphylococcus with negative coagulase, were the main pathogenic bacteria of infectious endophthalmitis.

A patient presented with a chief complaint of a conjunctival mass in the right eye for 5 days. The slit-lamp examination revealed a reddish oval mass, about 3 mm in diameter, in the nasal conjunctiva of the lower central fornix, with a clear boundary, smooth surface, toughness by touch, good activity, no bleeding, and no tenderness. The tumor was excised completely. Solitary fibrous tumor of the conjunctiva was diagnosed by pathological examination.

Objective:To compare the effect of fluorescence staining and periodic acid-Schiff staining in the diagnosis of fungal keratitis (FK).Methods:A total of 147 corneal specimens from 147 FK patients treated in Eye Hospital of Shandong First Medical University from January 2017 to May 2019 with positive corneal scraping or fungal culture were collected.Among them, there were 84 cases with penetrating keratoplasty (PKP), 42 cases with lamellar keratoplasty (LKP) and 21 cases with lesion resection.Another 11 cases with herpes simplex virus keratitis served as negative control.The corneal tissue specimens were performed with fungal fluorescence staining and periodic acid-Schiff staining, respectively.The stained sections were placed under fluorescence microscope and optical microscope to observe fungal hyphae or spores, respectively.The positive rates of the two staining methods were compared, and the positive cases of the diagnosis of FK in corneal tissue samples obtained by different surgical methods and corneal infection caused by different strains of the two staining methods were compared.Written informed consent was obtained from each patient.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Shandong Eye Hospital (No.SDSYKYY-2016012).Results:The positive rate of periodic acid-Schiff staining and fungal fluorescence staining was 60.5% (89/147) and 79.6% (117/147), respectively.The positive rate of fluorescence staining in the diagnosis of fungal keratitis was significantly higher than that of periodic acid-Schiff staining ( χ2=28.00, P<0.01), and both the specificity of the two staining methods was 100%.The positive rate of specimens obtained by PKP with fluorescent staining was 85.7% (72/84), and the positive rate with periodic acid-Schiff staining was 65.5% (55/84), and the difference was statistically significant ( χ2=17.00, P<0.01). The positive rate of specimens obtained by LKP with fluorescent staining was 71.4% (30/42), and the positive rate with periodic acid-Schiff staining was 52.4% (22/42), and the difference was statistically significant ( χ2=8.00, P<0.01). The positive rate of resected foci specimens with fluorescent staining was 71.4% (15/21), and the positive rate with periodic acid-Schiff staining was 57.1% (12/21), and the difference was not statistically significant ( χ2=1.30, P=0.25). The positive cases of two kinds of staining were different among different fungal strains.Among them, the positive cases of Fusarium solani complex, Pythium insidiosum, Aspergillus fumigatus complex, Candida guilliermondii, Trichoderma and Nigrograna mackinnonii with fluorescence staining were 19, 5, 5, 1, 1 and 1, and the positive cases of periodic acid-Schiff staining were 11, 0, 3, 0, 0 and 0, respectively.The staining results of the 11 negative controls were negative. Conclusions:Fluorescence staining is more sensitive than periodic acid-Schiff staining in the detection of fungal components in paraffin-embedded corneal tissues, and it can significantly improve the fungal detection rates.

为贯彻落实乡村振兴战略,加快提升基层医疗卫生服务能力,山东省选派优秀卫生人才到薄弱乡镇卫生院任"业务院长",山东第一医科大学附属眼科医院选派的"业务院长"通过建设眼科特色专科,由点带面逐步提升卫生院服务能力,短时间内带动了卫生院的发展.

AIM:To investigate the application value of fluorescent staining technique in the detection of amoebic pathogens in corneal tissue biopsy, and to apply fluorescent staining technique in the histopathological diagnosis of Acanthamoeba keratitis(AK), comparing the results with those of hemotoxyiln-eosin staining(HE staining)and periodic acid-schiff staining(PAS staining), and analyzing the sensitivity and specificity of these three staining methods.METHODS:Specimens of infected corneal tissue were collected from 74 cases(75 eyes), and then they were divided into an AK group and a non-Acanthamoeba keratitis(NAK)group based on the results of corneal scraping, culture and histopathological diagnosis. The tissues of consecutive sections were stained with HE staining, PAS staining and fluorescence respectively, and the sensitivity and specificity of the three staining methods for the diagnosis of AK were analyzed. Area under the curve(AUC)was calculated using the receiver operating characteristic(ROC)curve. Further analysis was performed to count the number of Acanthamoeba pathogens found by the three staining methods under the same magnification field of view at the same site, and to clarify the diagnostic value of fluorescent staining technique for AK.RESULTS: The sensitivity of HE staining was 69%(27/39)with a specificity of 92%; the sensitivity of PAS staining was 62%(24/39)with a specificity of 97%, and the sensitivity of fluorescent staining was 95%(37/39)with a specificity of 97%. There were differences in the sensitivity of the three staining methods for the diagnosis of AK(χ2=19.857, P<0.001), and pairwise comparison revealed that the differences between HE staining and fluorescent staining, PAS staining and fluorescent staining for the diagnosis of AK were statistically significant(P=0.003,<0.001), while the difference in sensitivity between HE staining and PAS staining for the diagnosis of AK was not statistically significant(P=0.978). The maximum AUC was 0.960 for fluorescence staining, followed by 0.804 for HE staining and 0.794 for PAS staining, respectively. The median number of amoeba cysts detected by HE staining, PAS staining and fluorescent staining at the same site under the same magnification field of view was 4(0, 11), 2(0, 9)and 12(3, 33), respectively(χ2=56.561, P<0.001). Pairwise comparison revealed that the differences in the number of amoeba cysts found by HE staining and fluorescence staining, PAS staining and fluorescence staining were statistically significant(P<0.001), while the difference in the number of amoeba cysts found by HE staining and PAS staining was not statistically significant(P=0.210). Fluorescently stained histopathological sections make it easier to identify amoebic pathogens.CONCLUSION:Fluorescent staining technique is more sensitive to histopathological diagnosis of AK than HE staining and PAS staining, which can significantly improve the positive rate of detection of amoebic pathogens.

Background To evaluate the relationship between corneal endothelial plaques and fungal hyphae infiltration in fungal keratitis. Methods Retrospective cross-sectional study of 60 fungal keratitis patients who underwent keratoplasty between January 2013 and March 2017. The endothelial plaques were graded as follows: grade 1, 1–3 endothelial plaques; grade 2, 4–8 endothelial plaques; and grade 3, more than 8 endothelial plaques or dense, merging endothelial plaques. The fungal pathogen culture and histopathology of diseased Descemet's membrane were evaluated. Results According to endothelial plaque grading, 3 patients were grade 1, 29 patients were grade 2, and 28 patients were grade 3. The PK surgery was performed in 57 patients with endothelial plaques of grade 2 and grade 3 and DALK surgery in 3 patients of grade 1. The predominating fungal pathogens were Aspergillus species (63.2%). All 57 patients with grade 2 and grade 3 had fungal hyphae in Descemet's membrane based on calcofluor white staining or PAS staining. In patients with grade 3, more hyphae and inflammatory cells were found in Descemet's membrane. The immunohistochemical staining of endothelial plaques revealed that CD15 and CD68 were positive in most cells. During the follow-up, 2 out of 3 patients who underwent DALK had recurrent fungal keratitis. Conclusions Endothelial plaques are considered as a sign of hyphae infiltrating Descemet's membrane. PK should be performed once plaques are detected in endothelium during the surgery.

Objective::To use in vivo laser confocal microscopy (IVCM) to observe the in vitro culture and living characteristics of candida spores and pseudohyphaes, and to provide abasis for the early diagnosis of candida keratitis.Methods::The data of 26 patients (26 eyes) who were diagnosed with candida keratitis in the Eye Hospital of Shandong First Medical University from January 2016 to December 2019 was collected. At the same time, candida albicans and candida parapsilosis were taken for laboratory fungal culture, and the typical morphology of candida spores and pseudohyphae in vitro and in vivo were observed by IVCM.Results::Candidaspores in vitro and in vivo presented uniformly in the shape of round spots with a diameter of 2-5 μm and a clear boundary. Pseudohyphae have a highly reflective linear structure. The reflection of spores was significantly enhanced in vivo. Eighteen eyes showed a scattered arrangement of spot-like, strongly reflective structure, and 11 eyes showed a dense fog structure. The morphology of pseudomycelia varied greatly. The mycelia in 2 eyes were slender, the spore structure was present in 5 eyes, and branches were visible. In 1 eye, an irregular thin and long rod shape with high contrast was observed, and in another eye, an irregular thin and long rod shape and spore structure could be observed simultaneously. Candida albicans pseudohyphae were relatively slender, with a length of 20-150 μm and a diameter of 2-10 μm. Pseudohyphae of candida parapsilosis were short and thick, with a length of about 30-100 μm and a diameter of 2-5 μm. Part of the branch spore structure was highlighted.Conclusions::Candida keratitis showstypical spore and pseudohyphae structures with IVCM. The morphology of candida keratitis spores in vitro and in vivo are consistent with observations under IVCM, but the morphology of pseudohyphaes are relatively different. IVCM can be used for the early diagnosis of candida keratitis.

目的 分析眼表肿物的临床特征、性质及其治疗方法.方法 对连续2年经我院治疗的50例(53只眼)眼表肿物进行分析.记录肿物临床体征.根据形态、大小、位置确定手术方法,手术方法根据肿物大小及位置分为4种:①单纯肿物切除,②肿物切除联合冷冻术,③肿物切除联合冷冻术联合羊膜移植术,④肿物切除联合部分板层角膜移植术.肿物切除常规病理检查确定性质、分析病理结果,术后观察发随访复发情况.结果 角结膜鳞状细胞癌形态呈菜花状且见松针样毛细血管扩张.角膜原位癌呈半透明或胶冻状白色,表面凹凸不平.色素痣扁平、黑色弥漫浸润,界限较清楚.结膜乳头状瘤呈桑葚或乳头状隆于表面.单纯肿物切除21例,肿物切除联合冷冻术17例,肿物切除联合冷冻术联合羊膜移植术10例,肿物切除联合部分板层角膜移植术2例.根据病理结果,恶性肿物共23例(46％),良性肿物27例(54％).恶性肿瘤可见异型性明显,角结膜鳞状细胞癌鳞状上皮增生活跃,呈浸润性生长,突破基底膜.角膜原位癌、角结膜上皮内瘤变基底膜完整.良性肿物结膜乳头状瘤呈乳头状,可见纤维血管轴心.色素痣见痣细胞呈巢团状分布.随访时间1 ～ 10年(平均4.8年),恶性肿物随访19例,其中4例复发.良性肿物随访20例,20例中均未复发.共失访11例,4例为恶性眼表肿物患者,7例为良性.结论 眼表肿物中恶性发病比例较高,发现眼表肿物应尽早切除,并行病理检查明确肿物性质.

Objective To analyze composition,distribution and characteristics of corneal and conjunctival tumors. Methods Clinical data,including patient ages,locations and pathological types of corneal and conjunctival tumors,were collected from 226 patients treated in our hospital between 2011 and 2017 and were analyzed retrospectively.Results Av-erage age is 29.7.Onset of malignant tumor is earlier than that of benign tumors and the difference was significant(t =-10.241,P <0.001).Malignant tumor is more likely to be found in older patients(≥40 years old).There is no differ-ence in the course of the disease between the two groups(Z=-0.618,P =0.537).The most common location is scleral margin(98 cases;43.36%), followed by conjunctiva(68 cases; 30.09%).Locations with highest rate of malignant tumors are fornix conjunctiva(33.3%), followed by cornea(25%), conjunctiva(15.4%), limbus(13.3%), inner canthus(12.5%), and bulbar conjunctiva(4.4%).Benign tumors are found in 202 cases(89.4%)and malignant tumors in 24 cases(10.6%).The most common benign tumors are dermoid tumor(65 cases;32.2%),followed by cysts (43 patients;21.3%), pigmented nevi(21 cases; 10.4%).Intraepithelial neoplasia is the most common malignant tumor that is found in 15 cases(62.5%),followed by carcinoma in situ(4 cases;16.7%),lymphoma and squamous cell carcinoma(2 cases each,8.3%).Conclusions Our findings showed that different corneal and conjunctival tumors have their own clinical and pathological features.Benign tumors and tumors of the limbus margin are the most common type. Fornical conjunctiva is the location where the highest rate of malignant tumor is found.These observations are useful in guiding clinical diagnosis for corneal and conjunctival tumors.

目的探讨散瞳对儿童眼球生物测量参数变化的影响。方法采用观察性研究办法。选取77名儿童（154只眼）作为研究对象,男性31名（62只眼）,女性46名（92只眼）,男女比例1:1.48;年龄5~15岁,平均年龄9.6岁,中位年龄10岁;选择复方托吡卡胺滴眼液散瞳,使用Lenstar分别测量77名儿童（154只眼）散瞳前后的角膜曲率（Kf和Ks）、前房深度（anterior chamber depth,ACD）、晶状体厚度（lens thickness,LT）以及眼轴长度（axial length,AL）值,分析散瞳前后测量的Kf和Ks、ACD、LT及AL结果的差异,符合正态分布的计量资料采用配对样本t检验,不符合正态分布的数据采用Wilcoxon带符号秩检验,测量结果差异与年龄的相关性比较采用Spearman相关性分析。以P＜0.05作为差异有统计学意义。结果散瞳后Kf（t=2.57,P=0.011）、Ks（Z=-2.39,P=0.017）、ACD（Z=-9.45,P＜0.01）、LT（t=8.05,P＜0.01）,改变差异均有统计学意义。AL（Z=-1.18,P=0.239）,改变差异无统计学意义。LT与ACD散瞳前后的差异与年龄相关（r=0.24,P=0.03;r=-0.32,P＜0.01）,Kf和Ks散瞳前后的差异与年龄不相关（r=0.11,P=0.187;r=0.05,P=0.525）。结论散瞳对儿童眼球生物测量参数有影响,其中角膜曲率（Kf和Ks）、ACD、LT会发生变化;ACD与LT散瞳前后的差异与年龄相关。

OBJECTIVE:To analyze the distribution of pathogenic bacterium of the fungal keratitis patients for providing the data of clinical diagnosis and treatment.METHODS:From July 2005 to December 2010 in Shandong Eye Hospital there were 352 smears of corneal ulcers and corneal tissue exemplar removed in surgery from fungal keratitis patients. The all exemplars were cultured with the Sabouraud dextrose agar culture media in 28°C under the humidor for 7 days. The strains was identified according to the appearance of fungal colonies, mycelium, spore shape, spore arrangement and fungal shape. And there did the retrospective analyses about the positive rate of fungal culture, genus distribution, seasonal distribution and sources of patients, sex ratio, age distribution and occupation. etc.RESULTS:There were 334 stock positive fungal culture in 352 cultured specimens from fungal corneal ulcers, the positive rate was 94.9%. There were 187 positive culture from 203 corneal scraping exemplars, the positive rate was 92.1%; there were 147 positive culture from 149 corneal tissue removed in surgery, the positive rate was 98.7%. The Fusarium strains was most common in all isolated strain, 211 (63.2%). The Aspergillus was secondly 47 (14.1%). The character of seasonal distribution of culture positive strain: the 48 strains (14.4%) were cultivated from January to March; the 48 strains (14.4%) were cultivated from April to June; the 64 strains were cultivated (19.2%) from July to September; the 174 strains (52.0%) were cultured from October to December, the ratio were 1:1:1.3:3.6 quarterly (χ(2) = 3.360, P = 0.339). The incidence of fungal keratitis were higher in the autumn and winter than in spring and summer. The ratio of the male and the female was 2.04:1 in 334 culture-positive patients; the mean age was (48 ± 22) years old. The 217(65%) came from farmer in the developed group, and the other 117 cases came from other occupations (35%). The 289 (87%) cases came from Shandong Province in 334 positive patients, the 45 cases (13%) came from other province of Province. Chi-square test method was used to analysis the differences of incidence of fungal keratitis among the four seasons using SPSS11.5.CONCLUSIONS:The Fusarium is the most important pathogen in fungal keratitis in Shandong Province. The high positive culture rate of fungal keratitis specimens plays an important role in clinical diagnosis and treatment.