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M. M. Fernandez, R. A. Rebong, N. A. Afshari; Microbiological Profiles and Clinical Outcomes in Fungal Keratitis: A Ten Year Study in the Southeastern United States. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2421.
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To review the clinical characteristics and outcomes of fungal keratitis at a tertiary referral center in the Southeastern United States over a 10-year period.
We identified all patients seen at the Duke Eye Center with CPT codes of 370.00 "corneal ulcer NOS", 370.03 "central corneal ulcer", 370.05 "mycotic corneal ulcer", 370.06 "perforated corneal ulcer", 370.8 "Keratitis NEC", and "370.9 Keratitis NOS",from January 1, 1998 through October 6, 2008. Each patient’s record was searched for cases of culture proven fungal keratitis. We reviewed each case to identify predisposing conditions including corneal surgery, poor immune status, diabetes, contact lens wear, and trauma. The clinical outcome of each eye was recorded.
A total of 4651 patients (13039 encounters) were treated for corneal ulcers during the studied period. Among these, 64 eyes had culture-proven fungal keratitis (11% of culture proven microbial ulcers), comprising of 68 fungal species. Fourty-five (66%) of the 68 species cultured were from filamentous forms while 21 (31%) were with Candida species and two were with other yeast forms. Cultures of two eyes grew both mold and yeast forms.Of the 64 eyes with fungal keratitis, 14 (22%) had prior corneal transplantation. Eighteen infections (28%) were in contact lens wearers; four had bandage contact lenses for epithelial defects and the other 14 were in eyes without history of ocular surface disease. Four eyes (6.3%) had neurotrophic ulcers, and three (4.7%) had other ocular surface disease. Seven (11%) patients reported an injury with vegetable matter. Ten (16%) patients had diabetes mellitus.After infection, twenty eyes (31%) underwent penetrating keratoplasty. Six eyes (9.4%) developed endophthalmitis. Six eyes (9.4%) were enucleated, eviscerated or became pthisical. The remaining ulcers resolved with treatment (n=14, 22%), were treated in follow-up by local providers (n=6, 9.4%), or had limited documentation for review but did not have subsequent eye surgery at our institution (n=16, 25%). Detailed treatment data was available for 29 patients; the average duration of antifungal therapy was 64 days.
Culture proven fungal keratitis is a rare occurrence that often requires penetrating keratoplasty and can have devastating sequelae. The majority of patients treated for fungal keratitis in this study had prior penetrating keratoplasty or contact lens use. In this geographic area, keratitis from filamentous fungi is more common than keratitis from yeast forms.
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