FUNGAL KERATITIS IN MAN

Andrew Tullo

Royal Eye Hospital, Manchester

INCIDENCE OF FUNGAL KERATITIS (FK)

• Developed world

6 -35% of all microbial keratitis

• Developing world

22 - >50%

Thomas PA Eye 2003;7:852

FUNGAL GROUPS

• Filamentous

- Aspergillus

- Fusarium

- Dematiaceous

• Yeasts

- Candida

Garg et al Cornea 2004;23:571

DISTRIBUTION (%)

NumberIndia(353)

Ghana(109)

Florida( 663 )

Pennsyl.(24)

Asperg. 30 17 21 4

Fusarium 37 42 52 25

Dematacia 15 10 19 0

Candida 0 1 7 46

FACTORS IN PATHOGENESIS

• Injury, ocular surface compromise

• Temperature

• Wind

• Humidity

• Urbanisation/employment

DIAGNOSIS

• Clinical features (diff.diagnosis)

• Microbiology

• Histopathology

• DNA amplification

ASPERGILLUS AND CORNEAL FOREIGN BODY

• 3 cases

• Medical “cure” (1), surgical “cure” (2)

• All required hospitalisation

• All had lasting visual impairment

Fahad et al Br J Ophthalmol 2004;88:847

DIAGNOSIS

• Clinical features

• Microbiology

• Histopathology

• DNA amplification

DIAGNOSIS

• Clinical features

• Microbiology

• Histopathology

• DNA amplification

HISTOPATHOLGY

• Haematoxylin and eosin (H&E)

• Periodic acid-Schiff (PAS)

• Grocott

DIAGNOSIS

• Clinical features

• Microbiology

• Histopathology

• DNA amplification

Gaudio et al Br J Ophthalmol 2002;86:755

OPTIMAL MANAGEMENT 1

• low threshold of suspicion

• biopsy even when scrape is negative

• appropriate topical therapy

• ?intracameral injection

Kaushik et al Cornea 2001;20:715

ANTIFUNGAL AGENTS 1

• Natamycin

• Amphotericin B

• Flucytosine

• Azoles

AZOLES

• Clotrimazole

• Miconazole

• Econazole

• Ketoconazole

• Itraconazole

• Fluconazole

• Voriconazole?

OPTIMAL MANAGEMENT 2

• avoidance of topical steroid?

• early surgery (up to 30%)

• systemic medication

OUTCOME

• Severity

- delay in diagnosis

- genus of fungus

• Treatment

- compliance

- toxicity

- availability

CONCLUSION

• FK rare in UK but ?increasing

• Outcome dictated by diagnosis, species and management

• Optimal treatment may include surgery, better medication and intracameral injection