Review of urgent penetrating keratoplasty for fungal keratitis outcome

Session Details

Session Title: Presented Poster Session: Infection & Imaging

Venue: Poster Village: Pod 2

First Author: : S.Montolío-Marzo SPAIN

Co Author(s): :    E. Alfonso-Muñoz   J. Piá-Ludeña   J. Davo-Cabrera   M. Roig-Revert   C. Peris-Martínez           

Abstract Details

Purpose:

Fungal keratitis remain as a diagnostic and therapeutic challenge. In endemic areas they represent a common cause of monocular blindness, specially in tropical regions. In Europe fungi are a rare cause of keratitis which contributes to delay diagnosis. Early clinical signs may be difficult to read leading to recurrent or persistent keratitis with severe prognosis. We reviewed the fungal keratitis referred to our center with confirmed microbiology or histopathology fungal cause and need of urgent penetrating keratoplasty.

Setting:

FISABIO Opthalmologia Médica, Valencia, Spain.

Methods:

Only those patients with confirmed hystopathological findings were included in this review. Most patients with suspected fungal infection could not be proven by microbiology or histopathology but clearly improved only after anti fungal drug administration. We report 8 patients referred to our center due to recurrent or persistent keratitis. Most of them had been treated during several months in their original hospital and all of them showed already compromised visual acuity and corneal integrity. Histological findings for these patients showed hyphae/yeast together with inflammatory changes, for a certain fungal keratitis diagnosis.

Results:

Diagnosis: 2 were initially diagnosed of fungal keratitis, 3 were diagnosed of chronic neurotrophic ulcers, 2 showed a persistent infiltrate, 1 was  diagnosed of persistent corneal edema after cataract surgery. Microbiology: 3 non-specific fungal infection, 2 Candida infection, 1 Aspergillus infection, 1 Fusarium infection and 1 Actinomyces infection. Antifungal treatment was given to every patient focusing on etiology: natamycin for filamentous fungi and amphotericin for yeast; alone or combined with voriconazole. Final outcome: 2 evisceration, 2 enucleation, 2 phthisis bulbi and two eyes with corneal opacity (visual acuity 0,45 and 1,3 logMAR respectively).

Conclusions:

Early detection of fungal keratitis plays a key role in visual prognosis. Those patients with fungal keratitis needing urgent penetrating keratoplasty will have a bad outcome despite intensive fungal therapy and aggressive surgical approach. The major objective in this subjects must be to preserve ocular integrity first, rather than visual acuity.

Financial Disclosure:

None