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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