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Fungal Keratitis: Emerging Trends and Treatment Outcomes

Iyer, Sandhya A. M.D; Tuli, Sonal S. M.D; Wagoner, Ryan C. B.S

Eye & Contact Lens: Science & Clinical Practice: December 2006 - Volume 32 - Issue 6 - p 267-271
doi: 10.1097/01.icl.0000249595.27520.2e

Purpose. To review the trends, risk factors, causative organisms, treatment, and outcomes of fungal keratitis at the authors’ institution.

Methods. A retrospective review of the records of consecutive patients diagnosed with fungal keratitis at the authors’ institution from January 1999 to June 2006.

Results. Eighty-four patients were diagnosed with fungal keratitis during this period. The average age of the patients was 48 years, and 64% were male. Until 2004, trauma (51%) and contact lens use (40%) were the major risk factors. After 2005, contact lens use (52%) surpassed trauma as the most common risk factor (29%). The percentage of fungal ulcers caused by nontherapeutic contact lenses increased from 21% between 1999 and 2001 to 32% between 2002 and 2004 and to 45% in 2005 and 2006. Eighty-six percent of cultured organisms were filamentous. Fusarium (41%) was the most commonly isolated genus, followed by Candida (14%), Curvularia (12%), and Aspergillus (12%). Visual acuity was worse than 20/200 in 56% of patients at presentation. Final visual acuity was 20/40 or better in 70% of patients treated with medication alone and 16% of patients requiring therapeutic keratoplasty. Surgical intervention in the acute phase was necessary in 23% of patients. Seventy-four percent of medically treated patients had dual topical antifungal therapy. Natamycin 5% and amphotericin B 0.15% were the most commonly used drugs.

Conclusions. Contact lenses are a major risk factor for fungal keratitis. The incidence of contact lens–related fungal keratitis was increasing even before the Fusarium outbreak in 2005 and 2006. Good visual outcomes can be achieved by aggressive dual topical antifungal therapy.

From the Department of Ophthalmology, University of Florida, Gainesville, FL.

Address correspondence and reprint requests to Dr. S.S. Tuli, PO Box 100284, 1600 SW Archer Road, Gainesville, FL 32610-0284; e-mail:

Accepted September 29, 2006.

© 2006 Lippincott Williams & Wilkins, Inc.