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Jordan Thompson, Darlene Miller, Richard K Forster, Stephanie De la O-Perez, Antonio Bermudez, Sander R Dubovy; Ocular Surface Dematiaceous Fungi: A Case Series of 120 Patients. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1499.
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Dematiaceous fungi represent a diverse group of fungi that can cause a variety of diseases affecting the globe and ocular adnexa, including keratitis and other ocular surface infections. They represent the third most common cause of fungal keratitis behind Fusarium and Aspergillus species and may present as raised pigmented conjunctival lesions due to melanin contained within their cell walls. The purpose of this case series was to determine the clinical, pathologic and microbiological characteristics of ocular surface dematiaceous fungal infections.
A retrospective chart review was performed on patients presenting from January 1996 to January 2013 with culture proven dematiaceous fungal infections of the cornea, conjunctiva and sclera (N=120). Surgical specimens sent to the Florida Lions Ocular Pathology Laboratory during the course of treatment were also reviewed and correlated with each clinical presentation.
Our case series shows that Curvularia species represent by far the most common etiologic dematiaceous fungal organism in ocular surface infections (68.3%), followed by Colletotrichum (9.2%) and Bipolaris (5.8%) species. The cornea is the most commonly affected anatomic site (92.5%), followed by the conjunctiva (8.3%) and sclera (2.5%), respectively.
Dematiaceous fungal infections of the ocular surface are most commonly caused by Curvularia species. They are more common in tropical climates and infection typically results from traumatic inoculation. The clinical presentations of dematiaceous fungi may mimic other ocular surface diseases, including malignant melanoma of the conjunctiva and other infectious causes of keratitis. It is thus imperative that clinicians remain aware of this infectious entity when evaluating patients with similar clinical presentations.
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