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Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre.
Klin Monbl Augenheilkd 2017; 234(4):419-425KM

Abstract

Background This review reports the epidemiology, laboratory results, treatment regimens and costs of fungal keratitis at a tertiary referral center in Lucerne, Switzerland. Patients and Methods Culture-proven fungal infections between January 2010 and December 2015 were reviewed retrospectively. Results Seventeen patients with a mean age of 52 years were identified. Contact lens wear was the most important risk factor (n = 11) (65 % of all cases), with filamentous fungi being identified as the most common fungus type (n = 10) (91 % of all cases of contact lens-associated fungal keratitis). All non-contact lens-associated fungal infections (n = 6) (35 % of all cases) were related to Candida spp. Six patients (35 %) were treated on an outpatient basis; 11 cases (65 %) required hospitalisation. Systemic voriconazole was the treatment regimen prescribed most often (n = 12) (71 %), followed by topical natamycin 5 % (n = 11) (65 %). Corneal crosslinking and penetrating keratoplasty were required in 4 cases each (24 %). One case ended up in enucleation (6 %). Average costs per case were EUR 15 952 for hospitalised patients if surgical intervention was required, and EUR 7415 if no intervention was performed. Average costs for outpatients were EUR 7079. In a majority of cases, visual acuity could be improved (n = 9) (53 %) or preserved (n = 2) (12 %). Conclusion Despite the relatively low incidence of culture-proven keratitis (17 cases in 6 years), a clear pattern with regard to risk factors and fungus species was noted. In the absence of a gold standard for the treatment of fungal keratitis, the combination of systemic voriconazole and topical natamycin seems to be one of the most commonly used antifungal treatment regimens. The costs of outpatient versus inpatient non-surgical treatment were approximately the same.

Authors+Show Affiliations

Dept. of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland (Chair: Michael A. Thiel).Dept. of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland (Chair: Michael A. Thiel).Dept. of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland (Chair: Michael A. Thiel).Dept. of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland (Chair: Michael A. Thiel).Dept. of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland (Chair: Michael A. Thiel).

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28376553

Citation

Iselin, K C., et al. "Fungal Keratitis: a Six-Year Review at a Tertiary Referral Centre." Klinische Monatsblatter Fur Augenheilkunde, vol. 234, no. 4, 2017, pp. 419-425.
Iselin KC, Baenninger PB, Schmittinger-Zirm A, et al. Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre. Klin Monbl Augenheilkd. 2017;234(4):419-425.
Iselin, K. C., Baenninger, P. B., Schmittinger-Zirm, A., Thiel, M. A., & Kaufmann, C. (2017). Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre. Klinische Monatsblatter Fur Augenheilkunde, 234(4), pp. 419-425. doi:10.1055/s-0042-123233.
Iselin KC, et al. Fungal Keratitis: a Six-Year Review at a Tertiary Referral Centre. Klin Monbl Augenheilkd. 2017;234(4):419-425. PubMed PMID: 28376553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre. AU - Iselin,K C, AU - Baenninger,P B, AU - Schmittinger-Zirm,A, AU - Thiel,M A, AU - Kaufmann,C, Y1 - 2017/04/04/ PY - 2017/4/5/pubmed PY - 2018/3/1/medline PY - 2017/4/5/entrez SP - 419 EP - 425 JF - Klinische Monatsblatter fur Augenheilkunde JO - Klin Monbl Augenheilkd VL - 234 IS - 4 N2 - Background This review reports the epidemiology, laboratory results, treatment regimens and costs of fungal keratitis at a tertiary referral center in Lucerne, Switzerland. Patients and Methods Culture-proven fungal infections between January 2010 and December 2015 were reviewed retrospectively. Results Seventeen patients with a mean age of 52 years were identified. Contact lens wear was the most important risk factor (n = 11) (65 % of all cases), with filamentous fungi being identified as the most common fungus type (n = 10) (91 % of all cases of contact lens-associated fungal keratitis). All non-contact lens-associated fungal infections (n = 6) (35 % of all cases) were related to Candida spp. Six patients (35 %) were treated on an outpatient basis; 11 cases (65 %) required hospitalisation. Systemic voriconazole was the treatment regimen prescribed most often (n = 12) (71 %), followed by topical natamycin 5 % (n = 11) (65 %). Corneal crosslinking and penetrating keratoplasty were required in 4 cases each (24 %). One case ended up in enucleation (6 %). Average costs per case were EUR 15 952 for hospitalised patients if surgical intervention was required, and EUR 7415 if no intervention was performed. Average costs for outpatients were EUR 7079. In a majority of cases, visual acuity could be improved (n = 9) (53 %) or preserved (n = 2) (12 %). Conclusion Despite the relatively low incidence of culture-proven keratitis (17 cases in 6 years), a clear pattern with regard to risk factors and fungus species was noted. In the absence of a gold standard for the treatment of fungal keratitis, the combination of systemic voriconazole and topical natamycin seems to be one of the most commonly used antifungal treatment regimens. The costs of outpatient versus inpatient non-surgical treatment were approximately the same. SN - 1439-3999 UR - https://www.unboundmedicine.com/medline/citation/28376553/Fungal_Keratitis:_A_Six_Year_Review_at_a_Tertiary_Referral_Centre_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0042-123233 DB - PRIME DP - Unbound Medicine ER -