June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Recent Trends and Risk Factors of Fungal Corneal Ulcers and Efficacy of Natamycin
Author Affiliations & Notes
  • Huikyung Kim
    Pusan National University Hospital, Busan, Korea (the Republic of)
  • Yeon Ji Jo
    Pusan National University Hospital, Busan, Korea (the Republic of)
  • Jong Soo Lee
    Pusan National University Hospital, Busan, Korea (the Republic of)
  • Footnotes
    Commercial Relationships   Huikyung Kim None; Yeon Ji Jo None; Jong Soo Lee None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 5161. doi:
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      Huikyung Kim, Yeon Ji Jo, Jong Soo Lee; Recent Trends and Risk Factors of Fungal Corneal Ulcers and Efficacy of Natamycin. Invest. Ophthalmol. Vis. Sci. 2023;64(8):5161.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The gold standard for the 1st line treatment of fungal keratitis has not been identified and Natamycin is the only antifungal medication approved by FDA. The purpose of this retrospective study is to assess the efficacy of Natamycin as the 1st line treatment of fungal keratitis and identify the recent trends and risk factors of fungal keratitis.

Methods : The records of 32 patients who were diagnosed as fungal keratitis in Pusan National University Hospital were studied retrospectively. In order to identify the recent trends, patients were divided into every 5 years. Age, sex, cultured bacteria type, cause of keratitis, visual acuity before and after treatment, size of ulcer at first visit, presence of hypopyon and treatments including surgery were searched. Also the good response to Natamycin was defined as a case in which the keratitis had improved.

Results : Total 32 patients were diagnosed with fungal keratitis. Their average age was 58 years old and 22 patients (71%) were male. Natamycin showed a good therapeutic effect (25 out of 32, 78%) as 1st line treatment and 7 patients (22%) underwent AMT due to uncontrolled inflammation and impending cornea perforation state. The risk factors of poor response of Natamycin were the larger size of ulcer, the presence of hypopyon and the past ocular surface disease (Multivariate Logistic Regression Analysis p<0.05). There was no significant difference of the type of fungus between the good and poor response group of Natamycin. (Chai square test, p=0.543)
At recent 5 years, the incidence of fungal keratitis under the age of 40 increased rapidly from 22% to 40%. In the last 5 years, Aspergillus (40%) was most common and in the recent 5 years Candida species (50%) was most common. (Chai square, p=0.041) Also the main cause of fungal keratitis was different. In the last 5 years, trauma (36%) was the main cause and in the recent 5 years, ocular surface disease (50%) was the main cause of fungal keratitis. (Chai square test, p=0.048)

Conclusions : Regardless of the type of fungus, Natamycin eye drop showed good therapeutic response in fungal keratitis and the size of ulcer, the presence of hypopyon and the history of ocular surface disease were involed in visual prognosis. The recent trend in increase of Candida spp. infection due to ocular surface disease in young patients under age of 40 suggests something to keep in mind when treating patients with infectious keratitis.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

 

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