Fungal keratitis in Songklanagarind Hospital

Abstract

Objective: To evaluate spectrum of disease and risk factors associated with corneal complication. Design: Retrospective study Material and Methods: A total of 76 medical records of fungal culture-positive keratitis treated at Songklanagarind Hospital from 1982 to 2003 were reviewed. Factors associated with corneal complication were analyzed. Results: Mean age of this group was 46.4 ± 16.3 years. Fifty five patients (71%) were males. Before the initial symptoms, 50 patients (66%) had a history of eye trauma from several materials, such as leaves, branches, dust and sand. The median delay between the initial symptoms and fungal keratitis treatment was 13.5 days (range 3-87 days). The most common fungi found were Fusarium species (71%). The initial topical antifungal drugs most frequently used were amphotericin B, ketoconazole and natamycin. Corneal complications included corneal perforation and near total corneal infiltration requiring further surgery such as penetrating keratoplasty, evisceration and enucleation. Being female, poor initial best-corrected visual acuity (BCVA) and having a longer treatment delay had a higher risk of corneal complication. Conclusion: Fusarium species is the most common cause of fungal keratitis in southern Thailand. Ophthalmologists should be concerned about corneal complications among patients who are female, have poor initial BCVA and delay of treatment.

Keywords

• fungal keratitis, fusarium species, corneal complication, corneal perforation, near total corneal infiltration, evisceration, enucleation, penetrating keratoplasty, female, best-corrected visual acuity