No abstract

Fungal keratitis is a devastating and difficult-to-treat ocular infection with high morbidity. Understanding geographic microbiological and clinical trends helps to guide rapid and effective treatment. We therefore report the characteristics and outcomes of fungal keratitis in Toronto, Canada over a twenty-year period. An electronic search of microbiology records at University Health Network, Toronto, ON, Canada identified all patients with positive corneal fungal culture over a 20-year period seen at our tertiary referral cornea practice. Review of corresponding patient charts identified demographic and microbiological details, clinical course, treatment regimen, and final outcomes associated with each episode of culture-positive fungal keratitis. Forty-six patients with fifty-one discrete fungal keratitis episodes were included. Five patients experienced recurrent fungal keratitis. Candida species accounted for 60.8% of positive fungal cultures, followed by Filamentous species at 35.3%. Preferred initial anti-fungal treatment was topical amphotericin at 36.7% followed by topical voriconazole at 32.6%. Surgical intervention was required in 48.9% with therapeutic penetrating keratoplasty being the most common procedure (22.4%). Final visual acuity (VA) of < 20/200 was attributed to 58% of patients in this study. Risk factors for poor outcomes included poor VA, topical steroid use at presentation, Candida involvement, history of ocular surface disease, organic ocular trauma, or prior corneal transplantation. Candida is the most frequent keratomycotic pathogen in Toronto. Risk factors for poor visual outcome include prior corneal transplantation, ocular surface disease/trauma, or pre-existing topical steroid use. Early suspicion, diagnosis and treatment are paramount for best clinical outcomes.

Cancer chemotherapy costs moneyEditor-I strongly endorse Sikora's claim that poor rates of survival from cancer in the United Kingdom reflect a lack of NHS resources. 1 Increasing the number of specialist oncologists will not, however, make up for the massive shortfall in funds required to provide these oncologists with the essential tools of their trade.Recent review of the budgetary allocation to Addenbrooke's Oncology Centre identified that, on average, £1700 a year is available to spend on drugs for any individual patient with cancer. Since a single course of chemotherapy may cost between £50 and £1500, oncologists cannot be expected to deliver the quality of care the public expects to receive. There are no other untapped sources of funding. Our clinical practice is already heavily subsidised: about one in six of all new patients with cancer referred to Addenbrooke's receives his or her standard chemotherapy courtesy of funds raised from industry sponsored research.The government cannot claim commitment to improving cancer care while patients are being denied effective treatments on the grounds of lack of affordability.