Fungal keratitis in the Republic of Ireland

Abstract

PurposeFungal keratitis is relatively rare in temperate climates with only one previous population-based study, which reported a minimum annual incidence of 0.32 per million population in the United Kingdom. We performed a nationwide study in the Republic of Ireland of cases over a 6-year period to establish the incidence, risk factors, treatment, and outcomes of fungal keratitis.Patients and methodsAll corneal scraping specimens positive for fungal species over a 6-year period were identified at the microbiology departments of the seven main ophthalmology units in the Republic of Ireland. Census data was used to establish national minimum annual incidence.ResultsForty-two eyes were treated for confirmed fungal keratitis during the 6-year period. This resulted in a minimum incidence of 1.53 cases per million population per year. Twenty-eight of 42 cases (67%) were due to filamentary fungi, with the most common species being Aspergillus. Pre-existing ocular surface disease was the most common risk factor constituting 42.9%; 26.2% underwent keratoplasty. No eyes underwent evisceration. Two eyes resulted in a level of vision of no perception of light. The mean LogMAR acuity in the remainder of cases was 0.89 with a range from -0.10 to 4.00.ConclusionThis study demonstrates a much higher minimum annual incidence than previously reported. The causative organism is highly related to risk factor. The range of visual outcomes remains broad in all subgroups. The wide range of outcomes and treatments used highlights the need for better evidence-based guidelines for fungal keratitis.

A single-centre retrospective observational study of fungal keratitis in Poland with a review of findings in Europe

“…Yeast causing fungal keratitis were mostly isolated in patients with known ocular surface disorders, those after previous ocular surgery (especially keratoplasty), and long-term users of topical corticosteroids. This is in keeping with the results of Nielsen et al [9,10,12,13,14]. In the current study, Fusarium spp.…”

“…In the presented sample, keratoplasty was eventually performed in 19 eyes (42.2%), more often in cases of keratitis caused by filamentous fungi. In the studies by Iselin et al , the percentage of patients receiving corneal grafts was lower than in the current sample, amounting to 24%, 26.2%, 31.6%, and 24.1%, respectively [8,12,13,14]. Nielsen E (Denmark) and Galarreta ), however, reported higher keratoplasty rates (52% and 46.2%, respectively) than in the current study [9,15].…”

“…Therefore, the aim of this study is to review the causes, presentation, and clinico-pathological associations of fungal keratitis in the Department of Ophthalmology in Katowice, Poland, in 2013-2017, and to compare the findings with previously published studies conducted in Europe in 2000-2019. The main difference here is that the presented study was a single centre study, whereas the other published data is from multicentre studies carried out in Ireland, United Kingdom, Germany, and Denmark [9,10,13,14,15]. In the current study, as well as in other European countries, the incidence of fungal keratitis was lower than reported by authors from, e.g.…”

“…The following search terms were used: "fungal keratitis", "keratomycosis", "pattern of fungal keratitis in Europe" and "epidemiology of mycotic keratitis". Ten published articles met the inclusion criteria [8][9][10][11][12][13][14][15][16][17][18]. The literature data was analysed in terms of gender, age, causes of fungal keratitis, and treatment outcomes in order to identify similarities and differences, and to enable further comparisons with the results obtained at the Department of Ophthalmology of the Railway Hospital in Katowice.…”

Global and Multi-National Prevalence of Fungal Diseases—Estimate Precision

“…In a recent 11-year prospective study evaluating visual outcomes of 1130 patients diagnosed with fungal keratitis from Larkana, Pakistan, 126 (11%) patients lost their eyeballs and over 50% of the remainder effectively lost their sight [ 154 ]. The incidence is lower in developed countries, for example a recent study from the Republic of Ireland estimated the minimum incidence of fungal keratitis at 1.53 cases per million population per year [ 155 ]. However, a large retrospective survey conducted in the U.K between 2004 and 2015 showed a rise in the annual incidence of fungal keratitis as percentage of all cases of microbial keratitis from 5.2% in 2004 to 9.5% in 2015 [ 156 ].…”