Update on fungal keratitis

Garg, Prashant; Roy, Aravind; Roy, Sanhita

doi:10.1097/icu.0000000000000272

Cited by 76 publications

(65 citation statements)

References 49 publications

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“…Finally, microbiological identification of certain fungi may be difficult as many filamentous moulds are slow-growing, 4,6 and some fungi such as Purpureocillium are best diagnosed with deep corneal biopsy rather than corneal scrapings. The existence of the state-wide pathology results database for the public healthcare sector has been of great assistance in obtaining epidemiological data.…”

Section: Discussionmentioning

confidence: 99%

“…2 Surgical therapy is frequently necessary; in one case series, 50% of all cases of microbial keratitis requiring penetrating keratoplasty were due to fungi. [5][6][7] The highest risk for fungal keratitis occurs in tropical developing countries with significant agricultural economic activity, where fungi may cause up to 50% of microbial keratitides. [5][6][7] The highest risk for fungal keratitis occurs in tropical developing countries with significant agricultural economic activity, where fungi may cause up to 50% of microbial keratitides.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology of fungal keratitis in Queensland, Australia

Chew

Woods

2018

Clinical Exper Ophthalmology

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In Queensland, fungal keratitis occurs most frequently in males under 50 with increased case identification associated with the hot dry season in tropical Queensland. The sex and age distribution may reflect increased environmental exposure to fungi related to occupation. The higher cumulative incidence in tropical Queensland is in keeping with the rates observed in other tropical regions of the world. Knowledge of the epidemiology of the condition is essential in formulating empirical antifungal regimens in suspected fungal keratitis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiology of fungal keratitis in Queensland, Australia

Chew

Woods

2018

Clinical Exper Ophthalmology

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“…Frequent administration of antifungal drugs topically is often required, particularly in the early stages of therapy (Garg et al 2016).…”

Section: Anti-fungal Drugsmentioning

confidence: 99%

Anti-Infective and Anti-Inflammatory Pharmacotherapies

Rosenblatt

2017

Handbook of Experimental Pharmacology

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Ocular infection and inflammation are common and are associated with myriad ocular conditions ranging from mild disease to blinding conditions. There are numerous anti-invectives with spectra against inciting pathogens. Given the potential for ocular infections to rapidly progress initial broad spectrum therapy is usually required, with therapy tailored as microbiological identification and sensitivities become available. The emergence of antibiotic resistance has become a major health problem. Anti-inflammatory therapy can be institutes to prevent ocular symptoms and end-organ damage. A therapy should be selected which is potent enough to interrupt the inflammatory cascades in play, but which avoids potential side effects. Glucocorticoids, NSAIDs, and biological agents may be used singularly or in combination. New drug delivery devices may allow for better local treatment of chronic ocular inflammation.

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“…Although the choice of antifungal drugs has been increasing, the challenge in management of fungal keratitis based on the fungal pathogens virulence among yeast species and host response [1]. drug delivery into the corneal tissues and of fungal pathogens play important roles in management of fungal keratitis [2]. Although various genera and species of fungi cause fungal keratitis, the drug susceptibility patterns make important evidence useful for fungal keratitis treatment [3].…”

Section: Introductionmentioning

confidence: 99%

Different Modalities of Antifungal Agents in the Treatment of Fungal Keratitis: A Retrospective Study

Nada¹,

Bor’i²,

Alsawad³

2017

J Clin Exp Ophthalmol

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Purpose: To evaluate the efficacy of different modalities of antifungal agents in the treatment, clinical features and therapeutic outcome of fungal keratitis Design: Retrospective observational case series. Methods:The study reviewed 251 eyes of 246 patients treated for moderate and severe fungal keratitis in the period from 2010 to 2015. The diagnosis of fungal keratitis based on the clinical characteristics features of fungal keratitis beside laboratory diagnosis. The antifungal drugs were determined according to the commercial availability at the time depending on the clinical features, also to some extent to the laboratory diagnosis. Ten different modalities of antifungal agents beside antibacterial agents and cycloplegic drugs were used.Results: Among the total treated 251 eyes, 194 eyes (77.29%) showed complete healed ulcers. But 121 eyes were treated by five groups of combined therapy of antifungal agents achieving healed ulcer in 97 eyes (80.16%). The study reported 10 groups of different modalities of antifungal agents. The highest curative rate was 88.46% in cases treated by combined therapy of corneal intrastromal injection of amphotericin B beside topical fluconazole with mean duration of healing (25.43 ± 4.09 days). The second rate was 84% in a combination of topical natamycine and subconjunctival injection of amphotericin B with mean duration of healing 27.95 ± 3.46 days. The shortest duration of healing was 24.83 ± 4.39 days in cases treated by a combination therapy of corneal intrastromal injection of voriconazole beside topical natamycine with curative rate 82.14%. Conclusions:The use of a combined therapy of antifungal agents achieved the best treatment modality in cases of fungal keratitis especially the combination of intrastromal injection of antifungal agents with topical one according to curative rate and duration of healed ulcers in cases of moderate and severe fungal keratitis.

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Update on fungal keratitis

Abstract: It is an interesting time in the history of mycotic keratitis with a lot of positive developments. Molecular methods will help improved diagnosis and clinico-therapeutic correlation. Drug delivery devices with superior pharmacokinetics are on horizon.

Cited by 76 publications

References 49 publications

Epidemiology of fungal keratitis in Queensland, Australia

Epidemiology of fungal keratitis in Queensland, Australia

Anti-Infective and Anti-Inflammatory Pharmacotherapies

Different Modalities of Antifungal Agents in the Treatment of Fungal Keratitis: A Retrospective Study

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