<p>A 10-Year Retrospective Clinical Analysis of Fungal Keratitis in a Portuguese Tertiary Centre</p>

Abstract

Purpose To determine the microbiological profile, risk factors, treatment and surgical intervention rates of fungal keratitis at a tertiary referral centre. Methods A retrospective review of microbiological and medical records from hospitalised patients treated for fungal keratitis at Centro Hospitalar Universitário de São João from 2009 to 2019 was conducted. Results Overall, 43 patients were included in our study. The mean age of patients was 63.7 years and 46.5% were men. In culture were isolated 22 (51.2%) filamentous fungi and 21 (48.8%) yeast. Candida species (n = 20, 46.5%), Fusarium species (n = 10, 23.4%) and Aspergillus species (n = 4, 9.3%) were the most common isolated species. Important risk factors were contact lens use (n = 24, 55.8%), long-term users of topical corticosteroids (n = 19, 44.2%) and previous keratitis (n = 19, 44.2%). Yeast isolates had a statistically significant higher prevalence in long-term users of topical corticosteroids compared to filamentous ones (p = 0.043). Twenty-four cases (55.8%) required surgical intervention, of which 23 cases underwent therapeutic penetrating keratoplasty. Ocular complications, such as evisceration was noted in 12 patients (27.9%) and endophthalmitis in 5 (11.6%). No statistically significant changes of best corrected visual acuity (BCVA) were found after treatment (p = 0.687). Conclusion Most patients with fungal keratitis have associated risk factors. Filamentous and yeast species have equally prevalent etiologies. In general, our results mirror how difficult and challenging the approach and treatment of fungal keratitis could be.

Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011–2020: A 10-Year Study

“…It is most commonly observed in tropical/subtropical countries and regions with prevalent agricultural activity, accounting for 23-63% of all IK cases in these regions [1,10,11]. Compared to bacterial keratitis, FK is more frequently associated with guarded visual prognosis, primarily caused by the significant diagnostic challenge (due to low and slow culture yield), the propensity to deeper infection affecting the posterior cornea, limited antifungal treatment option, and resistance to treatment [4,12]. In addition, many cases of FK usually require therapeutic keratoplasty to achieve complete resolution of the disease, with many of them affected by the recurrence of infection or uncontrolled infection progressing to endophthalmitis and eventuating in evisceration/enucleation [12][13][14][15][16].…”

Diagnosing Fungal Keratitis and Simultaneously Identifying Fusarium and Aspergillus Keratitis with a Dot Hybridization Array

“…Even for an experienced corneal physician, the diagnostic accuracy via slit lamp image was only about 76% [6]. Consequently, about 12 to 58% of FK patients needed therapeutic keratoplasty or other surgeries to quiet down their infection episodes [7][8][9], and the surgical cure rate of FK was the worst among various MKs [10]. Finally, up to 25% of FK patients might lose their vision [11].…”

Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011-2020: A 10-Year Study

“…1,10,11 Compared to bacterial keratitis, FK is more frequently associated with guarded visual prognosis, primarily caused by significant diagnostic challenge (due to low and slow culture yield), propensity to deeper infection affecting the posterior cornea, limited antifungal treatment option, and resistance to treatment. 4,12 In addition, many cases of FK usually require therapeutic keratoplasty to achieve completion resolution of the disease, with many of them affected by recurrence of infection or uncontrolled infection progressing to endophthalmitis and eventuating in evisceration / enucleation. [12][13][14][15][16] To date, the majority of the FK studies reported in the literature were conducted in developing or tropical / subtropical regions, including India, China and Nepal, where FK is more prevalent.…”

“…4,12 In addition, many cases of FK usually require therapeutic keratoplasty to achieve completion resolution of the disease, with many of them affected by recurrence of infection or uncontrolled infection progressing to endophthalmitis and eventuating in evisceration / enucleation. [12][13][14][15][16] To date, the majority of the FK studies reported in the literature were conducted in developing or tropical / subtropical regions, including India, China and Nepal, where FK is more prevalent. 4,[17][18][19][20][21][22][23] However, the results of those studies may not be readily applicable to populations in developed or temperate regions as the population characteristics, risk factors, underlying causes and management of FK can vary significantly.…”