A 10-Year Retrospective Clinical Analysis of Fungal Keratitis in a Portuguese Tertiary Centre

Abstract

Ana Maria Cunha,1 João Tiago Loja,2 Luís Torrão,1 Raúl Moreira,1 Dolores Pinheiro,3 Fernando Falcão-Reis,1,4 João Pinheiro-Costa1,5 1Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal; 2Faculty of Medicine, University of Porto, Porto, Portugal; 3Laboratory of Microbiology, Service of Clinical Pathology, Centro Hospitalar Universitário São João, Porto, Portugal; 4Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; 5Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, PortugalCorrespondence: Ana Maria CunhaDepartment of Ophthalmology of São João Hospital, Centro Hospitalar de São João, Avenida Prof. Hernâni Monteiro, Porto 4202 – 451, PortugalTel [phone]Fax [phone]Email [email protected]: 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.Keywords: fungal keratitis, risk factors, medical therapy, penetrating keratoplasty, visual outcomes

Keywords

• fungal keratitis
• risk factors
• medical therapy
• penetrating keratoplasty
• visual outcomes