Abstract
Purpose: :
Sixty–two cases of fungal keratitis examined at our department were retrospectively studied on their past history, clinical findings, fungal isolation, treatment and their effects. Key points in the treatment of fungal keratitis were emphasized.
Methods: :
Sixty–two cases of clinically suspected of fungal keratitis were examined and treated at our department between January, 1979 to March, 2005. Among them corneal scrapings were taken from 59 cases to confirm the diagnosis of fungal keratitis. Pimaricin was used as the drug of choice in most cases. However, other anti–fungal drugs were also used sometimes or combined with it. The criteria of efficacies for the treatment were decided according to the healing time of corneal ulcers.
Results: :
Fungi were isolated in 46 among 59 (78.0%) cases. All unconfirmed cases responded to pimaricin well. The most common isolate was Fusarium sp. from 12 cases. As clinical findings dirty white ulcer, irregular ulcer edge, hyphate ulcer and hypopyon were observed in 62 (100%), 44 (71.0%), 28 (45.2%) and 27 (43.5%) eyes, respectively. History of corneal trauma, steroid application and the use of contact lens were elucidated in 25 (40.3%), 13 (21.0%) and 6 (9.7%) eyes, respectively. Excellent, good, fair, bad and unclear effects were seen in 35 (56.5%), 15 (24.2%), 6 (9.7%), 4 (6.5%) and 2 (3.2%) eyes, respectively. The effect of pimaricin was related to its MIC of the isolates.
Conclusions: :
1) Fungal keratitis should be considered when corneal ulcers with dirty white color and the history of corneal trauma exist. 2) Pimaricin is still the drug of choice for the treatment of fungal keratitis. 3) The sooner the diagnosis and treatment are made, the better the prognosis is.
Keywords: fungal disease • keratitis • microbial pathogenesis: clinical studies