Clinical Characteristics and Outcomes of Rare Fungal Keratitis Caused by Plectosphaerella cucumerina: A Retrospective Case Series Analysis.

BACKGROUND

To characterize the clinical features and therapeutic outcomes of fungal keratitis caused by Plectosphaerella cucumerina.

MATERIALS AND

METHODS

A retrospective analysis was conducted on 13 patients diagnosed with P. cucumerina keratitis from July 2018 to April 2024. Clinical manifestations, microbiological identification, antifungal susceptibility profiles, treatment regimens, and prognostic indicators were evaluated.

RESULTS

All the 13 patients were farmers, and 6 of them had a history of trauma or the presence of a foreign body prior to the onset of symptoms. The main clinical manifestations were chronic progressive shallow corneal and middle stromal layer ulceration with dry ulcer surface, and moss formation was visible in 7 patients (7/13). No obvious immune ring structure and satellite lesions were observed in all patients. In vivo confocal microscopy (IVCM) showed that the mycelia showed medium strong reflection, some of them were changed like bamboo joints, most of them were 2-3 μm in diameter, and the arrangement was relatively neat and fasciculate. The Angle between the mycelia was small and most of them were acute angles. Drug sensitivity test showed that Amphotericin B, voriconazole and itraconazole were the main sensitive antifungal drugs. The main treatment was sensitive antifungal drugs combined with local lesion resection and voriconazole matrix injection. 2 cases with deep ulcers were treated with corneal transplantation.

CONCLUSIONS

P. cucumerina keratitis is relatively rare but distinct clinical entity. Diagnosis can be aided by corneal scraping, microbiological culture and IVCM. Emphasizing a comprehensive treatment approach involving medication, debridement, and surgical intervention is crucial to promote rapid healing of the ulcer.