Abstract
Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients (n = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4–92 years) and 51.3% of patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9 ± 16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67 ± 1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3 mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all p < 0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.
Highlights
The variations in the incidence and causes are mainly attributed to an underlying discrepancy in the risk factors, climate, access to a healthcare system, personal and environmental hygiene, and level of education [1]
Fungal keratitis (FK) is more frequently associated with guarded visual prognosis, primarily caused by the significant diagnostic challenge, the propensity to deeper infection affecting the posterior cornea, limited antifungal treatment option, and resistance to treatment [4,12]
Many cases of FK usually require therapeutic keratoplasty to achieve complete resolution of the disease, with many of them affected by the recurrence of infection or uncontrolled infection progressing to endophthalmitis and eventuating in evisceration/enucleation [12,13,14,15,16]
Summary
The variations in the incidence and causes are mainly attributed to an underlying discrepancy in the risk factors ( contact lens wear, trauma and ocular surface disease), climate, access to a healthcare system, personal and environmental hygiene, and level of education [1]. Fungal keratitis (FK) often poses significant diagnostic and therapeutic dilemmas. It is most commonly observed in tropical/subtropical countries and regions with prevalent agricultural activity, accounting for 23–63% of all IK cases in these regions [1,10,11]. FK is more frequently associated with guarded visual prognosis, primarily caused by the significant diagnostic challenge (due to low and slow culture yield), the propensity to deeper infection affecting the posterior cornea, limited antifungal treatment option, and resistance to treatment [4,12]. Many cases of FK usually require therapeutic keratoplasty to achieve complete resolution of the disease, with many of them affected by the recurrence of infection or uncontrolled infection progressing to endophthalmitis and eventuating in evisceration/enucleation [12,13,14,15,16]
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