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Fungal keratitis: emerging trends and treatment outcomes.
Eye Contact Lens 2006; 32(6):267-71EC

Abstract

PURPOSE

To review the trends, risk factors, causative organisms, treatment, and outcomes of fungal keratitis at the authors' institution.

METHODS

A retrospective review of the records of consecutive patients diagnosed with fungal keratitis at the authors' institution from January 1999 to June 2006.

RESULTS

Eighty-four patients were diagnosed with fungal keratitis during this period. The average age of the patients was 48 years, and 64% were male. 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 nontherapeutic contact lenses increased from 21% between 1999 and 2001 to 32% between 2002 and 2004 and to 45% in 2005 and 2006. Eighty-six percent of cultured organisms were filamentous. Fusarium (41%) was the most commonly isolated genus, followed by Candida (14%), Curvularia (12%), and Aspergillus (12%). 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 and 16% of patients requiring therapeutic keratoplasty. Surgical intervention in the acute phase was necessary in 23% of patients. Seventy-four percent of medically treated patients had dual topical antifungal therapy. Natamycin 5% and amphotericin B 0.15% were the most commonly used drugs.

CONCLUSIONS

Contact lenses are a major risk factor for fungal keratitis. The incidence of contact lens-related fungal keratitis was increasing even before the Fusarium outbreak in 2005 and 2006. Good visual outcomes can be achieved by aggressive dual topical antifungal therapy.

Authors+Show Affiliations

Department of Ophthalmology, University of Florida, Gainesville, FL, USA. stuli@ufl.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17099386

Citation

Iyer, Sandhya A., et al. "Fungal Keratitis: Emerging Trends and Treatment Outcomes." Eye & Contact Lens, vol. 32, no. 6, 2006, pp. 267-71.
Iyer SA, Tuli SS, Wagoner RC. Fungal keratitis: emerging trends and treatment outcomes. Eye Contact Lens. 2006;32(6):267-71.
Iyer, S. A., Tuli, S. S., & Wagoner, R. C. (2006). Fungal keratitis: emerging trends and treatment outcomes. Eye & Contact Lens, 32(6), pp. 267-71.
Iyer SA, Tuli SS, Wagoner RC. Fungal Keratitis: Emerging Trends and Treatment Outcomes. Eye Contact Lens. 2006;32(6):267-71. PubMed PMID: 17099386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fungal keratitis: emerging trends and treatment outcomes. AU - Iyer,Sandhya A, AU - Tuli,Sonal S, AU - Wagoner,Ryan C, PY - 2006/11/14/pubmed PY - 2007/2/21/medline PY - 2006/11/14/entrez SP - 267 EP - 71 JF - Eye & contact lens JO - Eye Contact Lens VL - 32 IS - 6 N2 - PURPOSE: To review the trends, risk factors, causative organisms, treatment, and outcomes of fungal keratitis at the authors' institution. METHODS: A retrospective review of the records of consecutive patients diagnosed with fungal keratitis at the authors' institution from January 1999 to June 2006. RESULTS: Eighty-four patients were diagnosed with fungal keratitis during this period. The average age of the patients was 48 years, and 64% were male. 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 nontherapeutic contact lenses increased from 21% between 1999 and 2001 to 32% between 2002 and 2004 and to 45% in 2005 and 2006. Eighty-six percent of cultured organisms were filamentous. Fusarium (41%) was the most commonly isolated genus, followed by Candida (14%), Curvularia (12%), and Aspergillus (12%). 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 and 16% of patients requiring therapeutic keratoplasty. Surgical intervention in the acute phase was necessary in 23% of patients. Seventy-four percent of medically treated patients had dual topical antifungal therapy. Natamycin 5% and amphotericin B 0.15% were the most commonly used drugs. CONCLUSIONS: Contact lenses are a major risk factor for fungal keratitis. The incidence of contact lens-related fungal keratitis was increasing even before the Fusarium outbreak in 2005 and 2006. Good visual outcomes can be achieved by aggressive dual topical antifungal therapy. SN - 1542-2321 UR - https://www.unboundmedicine.com/medline/citation/17099386/Fungal_keratitis:_emerging_trends_and_treatment_outcomes_ L2 - http://dx.doi.org/10.1097/01.icl.0000249595.27520.2e DB - PRIME DP - Unbound Medicine ER -