Clinical, microbiologic, and treatment outcomes of dematiaceous fungal keratitis - A retrospective study

Indian J Ophthalmol. 2024 Dec 1;72(12):1721-1727. doi: 10.4103/IJO.IJO_1881_23. Epub 2024 May 20.

Abstract

Purpose: Dematiaceous fungi, the third most common causative organism of fungal keratitis, constitute 3.5% to 43.5% of fungal keratitis worldwide. Several studies on filamentous fungi ( Aspergillus and Fusarium ) are available as opposed to that on dematiaceous fungal keratitis. This study aims to describe the profile of dematiaceous fungal keratitis in South India.

Methods: This institutional cohort study on culture-proven dematiaceous fungal keratitis was performed in a single ophthalmology referral center in South India for a 6-year period. Records were analyzed for demographic, clinical, microbiological, and treatment outcomes for 3 months from the date of presentation.

Results: This study comprised 312 cases involving dematiaceous fungal keratitis (DFK). During the study period, DFK accounted for 10% of microbial keratitis and 24.6% of fungal keratitis cases. The mean (standard deviation) age was 54 (14) years. Males were commonly affected (73.4%). Keratitis was ≤1/3 rd depth in 47.8% of cases. Fifty-four cases (17.3%) demonstrated surface pigmentation, and 69 cases (22.1%) had endothelial plaque. Curvularia spp. (99 eyes, 31.7%) was the most common fungal isolate among the speciated fungi. Topical medications resulted in the healing of 63.5% of cases. A total of 193 cases (79%) healed, and 49 cases had to undergo therapeutic penetrating keratoplasty (TPK). Early TPK was performed for 20 cases (40.8%). Seventeen eyes (34.6%) maintained clear grafts at the end of 3 months.

Conclusion: In this extensive study on DFK, we report a high incidence of this group of fungal keratitis. We found an excellent healing rate in our cohort of patients.

MeSH terms

  • Adult
  • Aged
  • Antifungal Agents* / therapeutic use
  • Cornea / microbiology
  • Cornea / pathology
  • Eye Infections, Fungal* / diagnosis
  • Eye Infections, Fungal* / drug therapy
  • Eye Infections, Fungal* / epidemiology
  • Eye Infections, Fungal* / microbiology
  • Eye Infections, Fungal* / therapy
  • Female
  • Follow-Up Studies
  • Fungi / isolation & purification
  • Humans
  • Incidence
  • India / epidemiology
  • Keratitis* / diagnosis
  • Keratitis* / drug therapy
  • Keratitis* / epidemiology
  • Keratitis* / microbiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Antifungal Agents