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Clinical and microbiological characteristics of fungal keratitis in the United States, 2001-2007: a multicenter study.
Ophthalmology. 2011 May; 118(5):920-6.O

Abstract

OBJECTIVE

To study the epidemiology, clinical observations, and microbiologic characteristics of fungal keratitis at tertiary eye care centers in the United States.

DESIGN

Retrospective multicenter case series.

PARTICIPANTS

Fungal keratitis cases presenting to participating tertiary eye care centers.

METHODS

Charts were reviewed for all fungal keratitis cases confirmed by culture, histology, or confocal microscopy between January 1, 2001, and December 31, 2007, at 11 tertiary clinical sites in the United States.

MAIN OUTCOME MEASURES

Frequency of potential predisposing factors and associations between these factors and fungal species.

RESULTS

A total of 733 cases of fungal keratitis were identified. Most cases were confirmed by culture from corneal scraping (n = 693) or biopsies (n = 19); 16 cases were diagnosed by microscopic examination of corneal scraping alone; and 5 cases were diagnosed by confocal microscopy alone. Some 268 of 733 cases (37%) were associated with refractive contact lens wear, 180 of 733 cases (25%) were associated with ocular trauma, and 209 of 733 cases (29%) were associated with ocular surface disease. No predisposing factor was identified in 76 cases (10%). Filamentous fungi were identified in 141 of 180 ocular trauma cases (78%) and in 231 of 268 refractive contact lens-associated cases (86%). Yeast was the causative organism in 111 of 209 cases (53%) associated with ocular surface disease. Yeast accounted for few cases of fungal keratitis associated with refractive contact-lens wear (20 cases), therapeutic contact-lens wear (11 cases), or ocular trauma (21 cases). Surgical intervention was undertaken in 26% of cases and was most frequently performed for fungal keratitis associated with ocular surface disease (44%). Surgical intervention was more likely in cases associated with filamentous fungi (P = 0.03). Among contact lens wearers, delay in diagnosis of 2 or more weeks increased the likelihood of surgery (age-adjusted odds ratio = 2.2; 95% confidence interval, 1.2-4.2).

CONCLUSIONS

Trauma, contact lens wear, and ocular surface disease predispose patients to developing fungal keratitis. Filamentous fungi are most frequently the causative organism for fungal keratitis associated with trauma or contact lens wear, whereas yeast is most frequently the causative organism in patients with ocular surface disease. Delay in diagnosis increases the likelihood of surgical intervention for contact lens-associated fungal keratitis.

Authors+Show Affiliations

The George Institute for Global Health, the University of Sydney, Sydney, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21295857

Citation

Keay, Lisa J., et al. "Clinical and Microbiological Characteristics of Fungal Keratitis in the United States, 2001-2007: a Multicenter Study." Ophthalmology, vol. 118, no. 5, 2011, pp. 920-6.
Keay LJ, Gower EW, Iovieno A, et al. Clinical and microbiological characteristics of fungal keratitis in the United States, 2001-2007: a multicenter study. Ophthalmology. 2011;118(5):920-6.
Keay, L. J., Gower, E. W., Iovieno, A., Oechsler, R. A., Alfonso, E. C., Matoba, A., Colby, K., Tuli, S. S., Hammersmith, K., Cavanagh, D., Lee, S. M., Irvine, J., Stulting, R. D., Mauger, T. F., & Schein, O. D. (2011). Clinical and microbiological characteristics of fungal keratitis in the United States, 2001-2007: a multicenter study. Ophthalmology, 118(5), 920-6. https://doi.org/10.1016/j.ophtha.2010.09.011
Keay LJ, et al. Clinical and Microbiological Characteristics of Fungal Keratitis in the United States, 2001-2007: a Multicenter Study. Ophthalmology. 2011;118(5):920-6. PubMed PMID: 21295857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and microbiological characteristics of fungal keratitis in the United States, 2001-2007: a multicenter study. AU - Keay,Lisa J, AU - Gower,Emily W, AU - Iovieno,Alfonso, AU - Oechsler,Rafael A, AU - Alfonso,Eduardo C, AU - Matoba,Alice, AU - Colby,Kathryn, AU - Tuli,Sonal S, AU - Hammersmith,Kristin, AU - Cavanagh,Dwight, AU - Lee,Salena M, AU - Irvine,John, AU - Stulting,R Doyle, AU - Mauger,Thomas F, AU - Schein,Oliver D, Y1 - 2011/02/04/ PY - 2010/03/18/received PY - 2010/09/10/revised PY - 2010/09/13/accepted PY - 2011/2/8/entrez PY - 2011/2/8/pubmed PY - 2011/7/9/medline SP - 920 EP - 6 JF - Ophthalmology JO - Ophthalmology VL - 118 IS - 5 N2 - OBJECTIVE: To study the epidemiology, clinical observations, and microbiologic characteristics of fungal keratitis at tertiary eye care centers in the United States. DESIGN: Retrospective multicenter case series. PARTICIPANTS: Fungal keratitis cases presenting to participating tertiary eye care centers. METHODS: Charts were reviewed for all fungal keratitis cases confirmed by culture, histology, or confocal microscopy between January 1, 2001, and December 31, 2007, at 11 tertiary clinical sites in the United States. MAIN OUTCOME MEASURES: Frequency of potential predisposing factors and associations between these factors and fungal species. RESULTS: A total of 733 cases of fungal keratitis were identified. Most cases were confirmed by culture from corneal scraping (n = 693) or biopsies (n = 19); 16 cases were diagnosed by microscopic examination of corneal scraping alone; and 5 cases were diagnosed by confocal microscopy alone. Some 268 of 733 cases (37%) were associated with refractive contact lens wear, 180 of 733 cases (25%) were associated with ocular trauma, and 209 of 733 cases (29%) were associated with ocular surface disease. No predisposing factor was identified in 76 cases (10%). Filamentous fungi were identified in 141 of 180 ocular trauma cases (78%) and in 231 of 268 refractive contact lens-associated cases (86%). Yeast was the causative organism in 111 of 209 cases (53%) associated with ocular surface disease. Yeast accounted for few cases of fungal keratitis associated with refractive contact-lens wear (20 cases), therapeutic contact-lens wear (11 cases), or ocular trauma (21 cases). Surgical intervention was undertaken in 26% of cases and was most frequently performed for fungal keratitis associated with ocular surface disease (44%). Surgical intervention was more likely in cases associated with filamentous fungi (P = 0.03). Among contact lens wearers, delay in diagnosis of 2 or more weeks increased the likelihood of surgery (age-adjusted odds ratio = 2.2; 95% confidence interval, 1.2-4.2). CONCLUSIONS: Trauma, contact lens wear, and ocular surface disease predispose patients to developing fungal keratitis. Filamentous fungi are most frequently the causative organism for fungal keratitis associated with trauma or contact lens wear, whereas yeast is most frequently the causative organism in patients with ocular surface disease. Delay in diagnosis increases the likelihood of surgical intervention for contact lens-associated fungal keratitis. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/21295857/Clinical_and_microbiological_characteristics_of_fungal_keratitis_in_the_United_States_2001_2007:_a_multicenter_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(10)00979-6 DB - PRIME DP - Unbound Medicine ER -