Fungal keratitis – current diagnosis and therapeutic possibilities

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Keratitis and subsequent damage to the cornea resulting from infectious causes is one of the most serious problems facing ophthalmology today. One of the most common etiologies is fungal infection. Symptoms range from pain and visual deterioration, Wessely ring, inflammatory reaction in the anterior chamber or ropost. Diagnosis in addition to the classic medical and ophthalmologic examination consists of microscopic examination of scrapings, Gram examination combined with culture gives a 90% chance of detecting a fungal etiology. Good results are also observed with PCR testing, which helps speed up diagnosis. Treatment is time-consuming and has a high risk of complications. Two techniques are used to treat fungal infections of the cornea, surgical and pharmacological, such as the antifungal polyene antibiotics nystatin, natamycin, amphotericin B or thiazole derivatives like fluconazole and voriconazole. For filamentous fungi, natamycin 5% or voriconazole 1% are used at various intervals. Natamycin, despite the much poorer availability of the drug in countries such as Africa, has much better clinical results along with a lower risk of complications, as confirmed by the MUTT. A big problem also is subsequent bacterial superinfection, leading to the need for topical antibiotics. Surgical treatment is used in case of failure of pharmacotherapy, up to 4 weeks after the diagnosis of the disease, but it carries a high risk of complications. In the early stages of the disease, a new cross-linking technique can be considered, which is described as an alternative to direct antifungal or antibacterial treatment.