Institutional members access full text with Ovid®

Share this article on:

Candida Keratitis: Emerging Problem in India

Sengupta, Jayangshu MS; Khetan, Archana MS; Saha, Suman MSc; Banerjee, Debdulal PhD; Gangopadhyay, Nibaran MS; Pal, Dipanjan MS

doi: 10.1097/ICO.0b013e31823f8a71
Clinical Science

Purpose To determine the epidemiological characteristics and outcome of Candida keratitis in a Cornea Care Unit of Kolkata-based tertiary eye hospital.

Methods A retrospective, noncomparative, observational case series involving patients of culture-proven fungal keratitis from January 2008 to December 2008. A total of 85 cases of culture-proven fungal keratitis were identified. Of these, 16 cases were caused by Candida sp and selected for the study. The records were analyzed for demographics, risk factors, mode of management (medical or surgical), indication of surgical therapy, and the response to treatment with final outcome. Medical therapy consisted of topical amphotericin B with or without intracameral application after obtaining culture reports. Surgical therapy included application of tissue adhesive with bandage contact lens and therapeutic keratoplasty.

Results All cases of Candida keratitis were caused by Candida albicans accounting for 16 cases [18.81%; 95% confidence interval (CI), 11.8–28.5] of total culture-positive fungal keratitis. We found postsurgical steroid therapy in 8 cases as most important association, followed by diabetes and trauma (4 cases each) as next common comorbidities. All patients required therapeutic keratoplasty. Surgical indications were corneal melt in 10 cases (62.5%; 95% CI, 38.5–81.6), extension up to limbus in 2 cases (12.5%; 95% CI, 12.2–37.2) and nonresponse with worsening in 4 cases (25%; 95% CI, 19.7–49.9). Final outcome consists of phthisis bulbi in 3 cases (18.8%; 95% CI, 5.8–43.8), failed graft in 7 cases (43.7%; 95% CI, 23–66.8), and clear graft in 6 cases (37.5%; 95% CI, 18.4–61.5).

Conclusions Candida is a new concern in developing countries like India. We are concerned about the poorer outcome, probably resulting from our unpreparedness and failure of medical therapy leading to more complication and requiring surgical intervention in higher numbers.

*Cornea and Ocular Surface Disease Clinic and

Ocular Microbiology Services, Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India

Department of Microbiology, Vidyasagar University, West Bengal, India

§Sanjibon Eye Care, Howrah, West Bengal, India

Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India.

Reprints: Jayangshu Sengupta, Cornea and Ocular Surface Disease Clinic, Priyamvada Birla Aravind Eye Hospital, 10,Loudon St, Kolkata, West Bengal, India 700017 (e-mail: jayansu@hotmail.com).

The authors state that they have no financial or conflicts of interest to disclose.

Received June 3, 2010

Accepted July 20, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.