Fusarium Keratitis—Review of Current Treatment Possibilities

Abstract

In many parts of the world, fungi are the predominant cause of infectious keratitis; among which, Fusarium is the most commonly isolated pathogen. The clinical management of this ophthalmic emergency is challenging. Due to the retardation of the first symptoms from an injury and the inability to differentiate fungal from bacterial infections based on clinical symptoms and difficult microbial diagnostics, proper treatment, in many cases, is postponed. Moreover, therapeutical options of Fusarium keratitis remain limited. This paper summarizes the available treatment modalities of Fusarium keratitis, including antifungals and their routes of administration, antiseptics, and surgical interventions.

Effectiveness of Voriconazole in Treating Fungal Keratitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…High MICs for antifungals are nee ded to treat Fusarium species in general, especially for VOR. This result was consistent in vitro studies as well as in vivo studies [28][29][30][31]. Other fungi, including Aspergillus and Candida species, are more susceptible than Fusarium species to azoles, particularly VOR [31].…”

A 5-Year Retrospective Analysis of the Risk Factors, Treatment, and Prognosis of Patients With Fungal Keratitis in Heilongjiang, China

“…Some reports have shown that oral voriconazole was an effective treatment for FK 30,31 . Other studies also reported the success of intracameral amphotericin B administration and corneal collagen crosslinking (CXL) for the treatment of FK 2,4,19 . In our study, no patients underwent removal of the diseased eye, and all the patients had recovered by the time of discharge.…”

“…large agricultural populations. If not properly treated, FK can lead to corneal destruction and endophthalmitis, with severe vision loss and even eyeball removal [1][2][3] .…”

“…The risk factors for FK are as follows: 1. a history of plant-related trauma; 2. contact lens use; 3. ocular surface disease; 4. lacrimal duct obstruction; 5. fungal skin infection; 6. long-term local or systemic antibiotic or steroid hormone use; and 7. others, including a history of eye surgery, eyelid abnormalities, etc. Plant-related trauma is the most common risk factor for FK 2,4,5 .…”

Fusarium Endophthalmitis: About a Case of Enucleation

“…Natamycin and amphotericin B, bind to ergosterol, stabilize fungal cell membrane and contribute to inhibition of amino-acid and glucose membrane transport proteins. Voriconazole is used to block the cytochrome p450, which results in a reduction of the ergosterol concentration in the membrane and its destabilization (25). In the case of endophthalmitis, surgery is a basic requirement, with which surgery is performed for keratectomy and corneal transplantation or even enucleation of the eye (26).…”