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 the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients (n = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4–92 years) and 51.3% of 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 (>3 mm), 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 outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.

Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series

“…However, in a real-world setting, diagnosis of infectious keratitis often poses significant diagnostic and therapeutic dilemmas, often due to indistinguishable clinical features shared among different causative organisms and polymicrobial infection [ 19 ]. Feathery infiltration and retrocorneal endothelial plaques are commonly associated with fungal keratitis [ 20 , 21 ]; however, in some cases, viral keratitis will mimic fugal keratitis and present with similar characteristics, which will be misdiagnosed easily and delay the treatment [ 18 , 22 ]. The inherent limitations of conventional microbiological testing such as variably low culture positivity rate and a long turnaround time are a recurrent theme in literature [ 19 ].…”

Big data in corneal diseases and cataract: Current applications and future directions

“…Studies have shown that the initial severity of the ulcer and presenting visual acuity serve as important prognostic factors for IK (Khoo et al, 2020 ; Ting et al, 2021a , c ). Therefore understanding the risk factors via big data research allows for effective implantation of various preventative strategies in reducing the incidence of IK.…”

Enhancing Clinical Decision-Making in Complex Corneal Disorders: The Role of In-Vivo Confocal Microscopy

“…The sooner the initial empirical treatment is consolidated to target the pathology, the more likely there will be a better outcome. Ting et al [ 13 ] summarized 10-years of results in fungal keratitis (FK) patients in the UK: 81.2% of 117 subjects included required hospitalization for intensive treatment with a mean hospitalization of 18.9 ± 16.3 days. Additionally, nearly 25% of the total cohort reported a final corrected distance visual acuity of perception of light or worse with up to 9.4% of cases where eye enucleation was required.…”