Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011-2020: A 10-Year Study

Abstract

Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. A total of 117 patients (n=117 eyes) with FK were included in this study. The mean age was 59.0±19.6 years (range, 4-92 years) and 51.3% patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9±16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67±1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all p<0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcome, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.

Achieving diagnostic excellence for infectious keratitis: A future roadmap

“…IK is a painful and potentially sight-threatening condition that often requires intensive medical and/or surgical interventions (Khor et al, 2018 ; Ting et al, 2021b ). Complications such as corneal melt, perforation, endophthalmitis and complete loss of the eye may sometimes ensue despite intensive treatment (Khor et al, 2018 ; Cabrera-Aguas et al, 2021 ; Ting et al, 2021b , c ). A timely and accurate diagnosis is often the key to a successful clinical outcome, though this is not always possible in clinical practice due to various barriers ( Table 1 ).…”

A 7-year review of clinical characteristics, predisposing factors and outcomes of post-keratoplasty infectious keratitis: the Nottingham infectious keratitis study

“…IK is a painful and sight-threatening condition that often requires intensive medical and/or surgical interventions. Several risk factors have been implicated in IK, including contact lens wear, trauma, ocular surface disease, and post-corneal surgeries, amongst others (Edwards et al, 2009;Khoo et al, 2019;Ting et al, 2021a;Ting et al, 2021b).…”

Comparison of Accelerated and Standard Corneal Collagen Cross-Linking Treatments in Experimental Fungal Keratitis for Aspergillus fumigatus

“…Fungal keratitis is a serious infectious corneal disease with a high rate of blindness [11][12][13]. For fungal keratitis, existing drugs mostly have low penetration, many side effects, and increasing drug resistance [14].…”

“…For fungal keratitis, existing drugs mostly have low penetration, many side effects, and increasing drug resistance [14]. Penetrating keratoplasty is often required in severe cases, but the lack of donor material makes treatment difficult [12,15,16]. Since Iseli et al reported 5 cases of fungal and bacterial infections successfully treated by CXL [17], scholars have increasingly applied it in the treatment of infectious corneal ulcers, and different CXL protocols have achieved good efficacy in both in vitro and in vivo studies [18][19][20][21][22][23][24][25].…”