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M. M. Ibrahim, F. M. Ibrahim, R. Vanini, R. S. Castro, S. J. Faria e Souza, E. M. Rocha; Clinical and Epidemiologic Aspects of Fungal Keratites in Brazil. Invest. Ophthalmol. Vis. Sci. 2007;48(13):353.
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© ARVO (1962-2015); The Authors (2016-present)
Fungal keratitis (FK) is a sight threatening disease, more prevalent in developing regions. The present work evaluates epidemiological and clinical aspects , visual outcome and predisposing factors in cases of FK treated in two referral ophthalmologic centers in Brazil.
Sixty -six patients with FK confirmed by microbiological analysis from January 2000 to December 2004 in two centers in São Paulo state, Brazil were included. It was analysed data related to age, time of occurrence, profession, causing factors, treatment time-length, etiologic agent, final visual acuity (VA) and therapeutic approaches. VA was categorized in 3 groups as indicted by World Health Organization, and improvement was considered when it was better or equal than in the presentation.
The male female ratio was 4.1:1. The most common age group affected was between 31 to 50 yr. Fifty percent of patients were in agriculture and 13 % in construction. People who work outdoor or live in rural area we totalize 69 % of the cases. A history of recent injury to the affected eye was obtained in 41 %. Injury with plant or animal material in 19 %. Preceding their initial visit to ours hospitals 68% were in use of antibacterial, 18% of antifungal and of 12% steroids topically. Our data revealed a trend of FK more often during the winter and spring seasons. The duration of symptoms experienced by patients prior to their presentation was up to 1 week in 30 % patients and between 2 weeks to more than 3 months in 72 %. Mycelia fungi were isolated in 91% cases and yeasts in 9%. The most frequent agent isolated was Fusarium species in 67 %, followed by Aspergillus species 11 %. In the presentation 52 % was blind, 9 % to have a sub-normal vision (SNV) and 39 % normal vision. After treatment 59 % was considered blind, 28 % to have a sub-normal vision and 13 % normal vision. If we consider visual improvement 44,5% got better and 55.5 % worse. The patients who presented as blind have low probability of VA improvent (p<0.01). The time duration of symptoms or until seek any treatment do not show any statistical relevance in visual improvement.
The present work confirms gender, age and profession prevalences in FK as reported in other countries. VA in presentation but not symptoms time-length or fungus specimen were good predictors of visual improvement. The present work show findings helpful for clinical decisions and suggest that further research should be dedicated to improve acess and better treatment for FK in developing countries.
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