This refers to a well-drafted article by Nath et al., published in a recent issue of the Indian Journal of Ophthalmology. We would like to draw attention to a few points. In the presented study, the authors found the presence of fungal elements by 10% KOH smear in only 65.2% cases, which is quite less than our practical experience and from the results of other studies.
Sharma et al., found fungal filaments in 100% and 81.2% of the corneal scrapings by the KOH method in the two phases of their study, while Gopinathan et al., found it to be 91% in their study. In most of the private practitioners and smaller centers where culture facilities are not available, KOH smear is the only reliable and easy-to-use diagnostic tool, and it works in 90–95% of the cases.
Secondly, the treatment of perforated fungal ulcers needs to be separated from the ulcers without perforations, as the eye can sometimes be saved only by therapeutic keratoplasty, although in smaller perforations cyanoacrylate glue also works very well.
1. Nath R, Baruah S, Saikia L, Devi B, Borthakur AK, Mahanta J. Mycotic corneal ulcers in upper Assam Indian J Ophthalmol. 2011;59:367–71
2. Sharma S, Silverberg M, Mehta P, Gopinathan U, Agarwal V, Naduvilath TJ. Early diagnosis of mycotic keratitis: Predictive value of potassium hydroxide preparation Indian J Ophthalmol. 1998;46:31–5
3. Gopinathan U, Garg P, Fernandes M, Sharma S, Athmanathan S, Rao GN. The epidemiological features and laboratory results of fungal keratitis: A 10-year review at a referral eye care center in South India Cornea. 2002;21:555–9
4. Sony P, Sharma N, Vajpayee RB, Ray M. Therapeutic keratoplasty for infectious keratitis: A review of the literature CLAO J. 2002;28:111–8
5. Garg P, Gopinathan U, Nutheti R, Rao GN. Clinical experience with N-butyl cyanoacrylate tissue adhesive in fungal keratitis Cornea. 2003;22:405–8