AIM:To study the clinical outcome and pathological base of lamellar keratectomy combined with natamycin medication for the treatment of fungal corneal ulcer. METHODS:Thirty-two eyes of 32 cases suffered from fungal corneal ulcer in which the endothelium was not infected were included in this study. All patients received lamellar keratectomy combined with natamycin medication. Visual acuity, corneal infiltration, clinical outcome, complications and fungal species were recorded. Pathological examinations were conducted with the corneal lamellar tissues. RESULTS:Twenty cases had a preoperative visual acuity below 0.05，11 cases between 0.05 and 0.3，and 1 case between 0.3 and 1.0. Twenty-eight cases were healed by lamellar keratectomy combined with natamycin medication. The heal course ranged from 7 to 32 days, with an average time of 13.2±8.5 days. Postoperative evaluation showed that 5 cases had a visual acuity below 0.05，8 cases between 0.05 and 0.3，15 cases between 0.3 and 1.0. Four cases converted to keratoplasty due to uncontrolled infection. Positive cultures were found in 31 cases with 18 Fusarium species, 8 Aspergillus species, 3 Alternaria species and 2 uncertain species. Pathological examination showed dense infiltration of polymorphonuclears(PMNs), and periodic acid-schiff(PAS) staining demonstrated most hyphae lay in superior corneal lamellae and parallel to it, while little hyphae traversed the cornea in a plane perpendicular or inclined to the stromal lamellae. There was no significant difference in growth patterns in cornea between different pathogenic fungi. CONCLUSION: Timely lamellar keratectomy can significantly improve the efficiency of natamycin medication in fungal corneal ulcer and restore visual acuity.