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Gina M. Rogers, Kenneth M. Goins, Anna S. Kitzmann, Nasreen A. Syed, Michael D. Wagoner; 10 year experience of fungal keratitis at the University of Iowa. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6170.
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To evaluate and compare the potential risk factors for the development of fungal keratitis, determine the likelihood of medical or surgical cure, and evaluate the outcomes of therapeutic keratoplasty (TKP) and optical keratoplasty (OKP) in the management of medically unresponsive fungal keratitis and post-keratitis scarring, respectively.
Retrospective review of all cases of culture or biopsy positive fungal keratitis treated at a single center (University of Iowa Hospitals and Clinics) between October 1st, 2001 and September 30th, 2011 and had follow up for a minimum of three months. Main outcome measures were determination initial microbial cure either by medical or surgical therapy and final outcome (visual acuity) including measures for visual rehabilitation or complications encountered.
66 eyes of 66 patients met inclusion criteria. 22 eyes required at least one keratoplasty for fungal cure, at least 50% of these cases required a second keratoplasty for visual rehabilitation. Eyes treated with TKP were less likely to obtain visual acuity of 20/40 or better and more likely to have vision of 20/200 or worse. Final statistical analysis is still pending. Candida keratitis seems to have the best prognosis for medical cure.
Therapeutic keratoplasty can successfully treat medically unresponsive cases of fungal keratitis, although multiple grafts may be required and the visual prognosis is guarded. Optical keratoplasty performed after resolution of active keratitis is associated with an excellent prognosis for both graft survival and visual outcome.
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