Fungal Keratitis: Diagnosis, Management, and Recent Advances

Abstract

Fungal keratitis is one of the major causes of microbial keratitis that may lead to corneal blindness. Many problems related to diagnosis and therapy are encountered in fungal keratitis, including difficulty in obtaining laboratory diagnoses and the availability and efficacy of antifungal medications. Intensive and prolonged use of antifungal topical preparations may not be enough. The use of antifungal medications is considered the main treatment for fungal keratitis. It is recommended to start antifungal therapy after confirmation of the clinical diagnosis with a smear or positive cultures. Topical application of antifungal medications is a mainstay for the treatment of fungal keratitis; however, systemic, intra-stromal, or intra-cameral routes may be used. Therapeutic keratoplasty is the main surgical procedure approved for the management of fungal keratitis with good success rate. Intrastromal corneal injection of antifungal medications may result in steady-state drug levels within the corneal tissue and prevent intervals of decreased antifungal drug concentration below its therapeutic level. In cases of severe fungal keratitis with deep stromal infiltration not responding to treatment, intracameral injection of antifungal agents may be effective. Collagen cross-linking has been proposed to be beneficial for cases of fungal keratitis as a stand-alone therapy or as an adjunct to antifungal medications. Although collagen cross-linking has been extensively studied in the past few years, its protocol still needs many modifications to optimize UV fluence levels, irradiation time, and concentration of riboflavin to achieve 100% microbial killing.

Etiopathology, Epidemiology, Diagnosis, and Treatment of Fungal Keratitis

“…Results from PCR may be reported within a few hours, contrasting with the 2–14 days often required by culture methods . The limitations associated with the use of PCR include its high cost, inability to conduct drug sensitivity testing, challenges in monitoring therapeutic effectiveness, and the potential for false-positive findings resulting from contamination …”

“…Similarly, incorporating adjuvant antifibrotic drugs into the management of infectious corneal ulcers could significantly enhance ocular therapeutics aimed at preventing blindness. Recent publications have addressed fungal keratitis (FK), covering aspects of diagnosis, management, and recent advancements. , However, these reports offers limited information regarding epidemiological data and pathology associated with FK. Additionally, they have primarily reviewed research focused on formulation-based treatment approaches for managing FK, primarily relying on clinical findings. , …”