Clinical analysis of microbiologically proven fungal keratitis according to prior topical steroid use: A retrospective study in South Korea

Abstract

Background: To compare the clinical characteristics and treatment outcomes of microbiologically proven fungal keratitis between users and non-users of prior topical steroids (PS and NPS, respectively) Methods: Eighty-three cases with microbiologically proven fungal keratitis between January 2000 and December 2016 retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and compared between the PS and NPS groups. Treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated using multivariate logistic regression in the overall cohort. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. Of these, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. Candida was the most common organism in both groups (6 cases, respectively), while Aspergillus (4 cases) was found only in the PS group (p=0.103). No significant differences were observed in the mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting best-corrected visual acuity (BCVA) between the two groups. Differences were observed between the PS and NPS groups in terms of previous ocular surface disease (OSD) (43.3% vs. 22.6%, p=0.048) and deep infiltration (53.3% vs. 32.1%, p=0.057). Regarding treatment outcomes, final BCVA <0.1 (60% vs. 44.2%, p=0.133), the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029), and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The significant risk factors for treatment failure were hypopyon (odds ratio [OR] 6.01, p=0.005) and deep infiltration (OR 4.38, p=0.013). Conclusions: Previous OSD and deep infiltration were more common in the PS group compared to the NPS group. The PS group also experienced worse disease progression and treatment outcomes. These results highlight the need for paying attention to the use of steroids in clinical practice.

Clinical Comparison of Fusarium Keratitis according to the Initial Potassium Hydroxide (KOH) Smear: A Retrospective Study in South Korea

“…Lalitha et al [29] reported that the presence of hypopyon was a signifcant predictor of treatment failure in fungal keratitis. Cho and Lee [30] stated signifcant risk factors for treatment failure were hypopyon and deep infltration in microbiologically proven fungal keratitis. In this study about Fusarium keratitis, deep corneal infltration and hypopyon were signifcant in univariate logistic regression analysis, but their efects were attenuated in multivariate regression analysis.…”

Use of Topical Cyclosporine 0.1% in Therapeutic Penetrating Keratoplasty for Fungal Keratitis

“…Numerous studies have shown that topical corticosteroids are not only risk factors for the causation of fungal keratitis, 5,6 but also worsen the clinical course of fungal infection. [7][8][9][10] Because topical or systemic antifungal drugs do not achieve fungicidal concentrations within the cornea, concurrent treatment with topical corticosteroids aggravates fungal keratitis because of unbridled proliferation of fungi. 9,11,12 Conventionally, topical corticosteroids are advised few weeks after TPK when the risk is low, but by this time, many grafts fail.…”