2007 OMIG, Abstract 21

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Fungal Keratitis: Emerging Trends and Treatment Outcomes
SS Tuli, SA Iyer, WT Driebe.
University of Florida, Gainesville, FL

Purpose:  To review the trends, risk factors, causative organisms, treatment and outcomes of fungal keratitis at the University of Florida.
Methods:  Retrospective review of the medical records of consecutive patients with fungal keratitis presenting to our institution from January 1999 to June 2006.
Results:  84 patients were diagnosed with fungal keratitis over this period. The average age was 48 years and 64% were male. The most productive laboratory investigation was corneal scraping for GMS staining which yielded an 85% rate of positivity. Until 2004, trauma (51%) and contact lens use (40%) were the major risk factors. After 2005, contact lens use (52%) surpassed trauma as the most common risk factor (29%). The percentage of fungal ulcers caused by non-therapeutic contact lenses increased from 21% in 1999-2001 to 32% in 2002-2004 and 45% in 2005-2006. 86% of cultured organisms were filamentous. Fusarium (41%) was the most commonly isolated, followed by Candida (14%), Curvularia (12%) and Aspergillus (12%). Surgical intervention in the acute phase was needed in 23% of patients. 74% of medically treated patients had dual topical antifungal therapy. Natamycin 5% and Amphotericin B 0.15% were the most commonly used drugs. Visual acuity was worse than 20/200 in 56% of patients at presentation. Final visual acuity was 20/40 or better in 70% of patients treated with medication alone (N=36) but only 16% of patients requiring therapeutic keratoplasty (N=3).
Conclusions:  Contact lenses are a major risk factor for fungal keratitis. Contact lens related fungal keratitis was increasing even prior to the Fusarium outbreak in 2005-2006. Good visual outcomes can be achieved by aggressive dual topical antifungal therapy.

Disclosure code: N

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