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Gerd Geerling; The German keratomycosis registry - results of a multi-center study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):847.
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© ARVO (1962-2015); The Authors (2016-present)
Mycotic keratitis, still relatively rare in Germany is a very serious condition with a potentially sight-threatening course. The number of cases seems to be increasing, but targeted data collection has, until recently, not been established . The German keratomycosis registry was founded on a joint initiative of the German National Reference Center for Invasive Fungal Infections and the University Eye Hospital Dusseldorf in 2015. The present work is the first interim report of the registry.
The registry includes retro- and prospective patient data. Data recorded include: the presence of mycotic keratitis confirmed by PCR; culture; histology or confocal microscopy. Among other, the following parameters are collected: date of symptom onset; date and method of diagnosis; detailed history (in particular for the use of contact lenses and other possible risk factors, like trauma, immunosuppression, etc.); visual acuity and findings at admission and follow-up, and conservative or surgical therapy.
To date, 102 cases were reported by 16 German eye clinics (64.3% female, mean age 52 years, 18-95 years). Fungal keratitis was the initial diagnosis in only 20.6%. The most common initial diagnosis was bacterial keratitis (40.2%). The time to correct diagnosis averaged 31.7 ± 46.9 (0-296) days. The diagnosis was confirmed by culture in 74.5%, histologically in 30.4%, by PCR in 28.4% and confocal microscopy in 27.4%. The following fungal genera were identified: Fusarium spp. (36.7%), Candida spp. (35.8%), Aspergillus spp. (6.4%) and others (21.1%). The most important risk factor was the use of contact lenses. The most commonly used antifungal agent was voriconazole (64.7%) followed by amphotericin B (37.2%). Keratoplasty was performed in 65.7% of the cases and 8.8% of the affected eyes were enucleated. Visual acuity increased from initially 0.16 ± 0.25 (0.001-1.0) decimal to 0.28 ± 0.34 (0-1.0) decimal at the end of the study-period.
The correct diagnosis of keratomycosis is often delayed. The therapy can be very difficult and keratoplasty is often necessary. Due to the rarity of this disease data must be collected from many centres in order to gain a better understanding of of the pathogenesis; to recognize possible previously unknown risk factors and a change in the spectrum of pathogens; and to identify approaches to therapy optimization. The German Fungus Keratitis Registry will fulfill this requirement.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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