Journal of ophthalmic inflammation and infection · 2025
Clinical profile and outcomes of dematiaceous fungal keratitis - data from a secondary center in rural North India.
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Mehta Sonali, Patel Nikunj Vinodbhai, Gandhi Arpan, Chaudhari Isha, Majumdar Atanu, Mathur Umang, Acharya Manisha
Аннотация
PURPOSE: To evaluate the clinical course, factors contributing to healing, and outcomes of medically treated dematiaceous fungal keratitis (DFK) at a rural secondary eye care center in North India.
METHODS: This retrospective, electronic medical record-based study was conducted over one year at a secondary care center. Patients of all age groups with culture-proven DFK who completed follow-up until corneal healing were included. Demographic, clinical, and microbiological data were analyzed. All patients received therapeutic debridement and natamycin monotherapy. Voriconazole was added in non-responders, and oral antifungals were used for corneal melt or posterior segment involvement. Cases requiring therapeutic keratoplasty (TPK) or evisceration were classified as poor outcomes.
RESULTS: Hundred and eight eyes were included in the study. The mean age was 43.2 years, with 78.7% males. Trauma, most commonly from sugarcane leaves, was reported in 80.6%. Ulcers were mild in 50%, moderate in 39.8%, and severe in 10.2%. Half were small in size; 89.8% were superficial, while 5.6% showed full-thickness involvement. Neurotrophic-like defects were seen in 48.5% and significantly associated with ulcer size (p = 0.004). Healing occurred within 2 weeks in 44.5% and within 4 weeks in 33.7%. Delayed healing (21.8%) correlated with larger, deeper ulcers, hypopyon, and neurotrophic-like defects. TPK/evisceration (12%) was significantly associated with prior steroid use, vascularization, hypopyon, and corneal melt (p < 0.05).
CONCLUSION: Despite prolonged healing, DFK has a high resolution rate with appropriate medical therapy, minor procedures, and complete debridement. Poor prognostic factors include large and deep infiltrates, hypopyon, and prior steroid use.
METHODS: This retrospective, electronic medical record-based study was conducted over one year at a secondary care center. Patients of all age groups with culture-proven DFK who completed follow-up until corneal healing were included. Demographic, clinical, and microbiological data were analyzed. All patients received therapeutic debridement and natamycin monotherapy. Voriconazole was added in non-responders, and oral antifungals were used for corneal melt or posterior segment involvement. Cases requiring therapeutic keratoplasty (TPK) or evisceration were classified as poor outcomes.
RESULTS: Hundred and eight eyes were included in the study. The mean age was 43.2 years, with 78.7% males. Trauma, most commonly from sugarcane leaves, was reported in 80.6%. Ulcers were mild in 50%, moderate in 39.8%, and severe in 10.2%. Half were small in size; 89.8% were superficial, while 5.6% showed full-thickness involvement. Neurotrophic-like defects were seen in 48.5% and significantly associated with ulcer size (p = 0.004). Healing occurred within 2 weeks in 44.5% and within 4 weeks in 33.7%. Delayed healing (21.8%) correlated with larger, deeper ulcers, hypopyon, and neurotrophic-like defects. TPK/evisceration (12%) was significantly associated with prior steroid use, vascularization, hypopyon, and corneal melt (p < 0.05).
CONCLUSION: Despite prolonged healing, DFK has a high resolution rate with appropriate medical therapy, minor procedures, and complete debridement. Poor prognostic factors include large and deep infiltrates, hypopyon, and prior steroid use.