The outcome of microbiologically proven fungal keratitis following standard treatment protocol

Abstract

To describe the baseline characteristics, microbiological spectrum, therapy and assess the visual outcome in patients proven with fungal keratitis following standard treatment protocol. This longitudinal study was reviewed all patients with culture-proven fungal keratitis over a year at a tertiary referral facility in Bangladesh. All of the patients who had corneal stromal infiltrates had their corneal scrapings subjected to the normal microbiologic examination process, as well as a smear and culture-guided antimicrobial medication. Epidemiological features of patients (n=100), the mean age of patients was 55.6±9.8 years. More in the age group 51 to 60 years (28%). Males were more predominant (67%), commonly come from rural areas (59%). More were agriculture in workers (57%). Predisposing factors in fungal keratitis were trauma with vegetative matter (58%), herpetic keratitis (16%), penetrating keratoplasty (10%), extended wear of contact lens(12%), LASIK(4%). Treatment taken by another ophthalmologist before the presentation (46%). Low vision (20/50 to 20/160) was found in 58% cases and legal blindness (20/200 to worse ) was 40% of cases on visual acuity test at presentation. Filamentous Aspergillus (68%), Fusarium (2%), Scedosporium species (6%) and Candida(20%) were found by doing culture. Surgical intervention was needed in 36% of cases with topical and systemic anti fungal medications for management. Visual acuity after treatment was 20/40 or better in 16% of cases, low vision (20/50 to 20/160) in 39% of cases and legal blindness (20/200 to worse) in 45% of cases. Fungal keratitis causes irreparable vision damage. Yeast infections were less common than infections with filamentous fungus, which were typically treated more aggressively through both medicinal and surgical means. Similar durations of infections and visual results were observed in filamentous and yeast keratitis. In 80% of the cases where it was done, antifungal susceptibility testing had an impact on the course of treatment.