FUNGAL KERATITIS IN MAN

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FUNGAL KERATITIS IN MAN

• Andrew Tullo
• Royal Eye Hospital, Manchester

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INCIDENCE OF FUNGAL KERATITIS (FK)

• Developed world
• 6 -35 of all microbial keratitis
• Developing world
• 22 - gt50
• Thomas PA Eye 20037852

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FUNGAL GROUPS

• Filamentous
• - Aspergillus
• - Fusarium
• - Dematiaceous
• Yeasts
• - Candida
• Garg et al Cornea 200423571

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DISTRIBUTION ()
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FACTORS IN PATHOGENESIS

• Injury, ocular surface compromise
• Temperature
• Wind
• Humidity
• Urbanisation/employment

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DIAGNOSIS

• Clinical features (diff.diagnosis)
• Microbiology
• Histopathology
• DNA amplification

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ASPERGILLUS AND CORNEAL FOREIGN BODY

• 3 cases
• Medical cure (1), surgical cure (2)
• All required hospitalisation
• All had lasting visual impairment
• Fahad et al Br J Ophthalmol 200488847

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DIAGNOSIS

• Clinical features
• Microbiology
• Histopathology
• DNA amplification

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DIAGNOSIS

• Clinical features
• Microbiology
• Histopathology
• DNA amplification

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HISTOPATHOLGY

• Haematoxylin and eosin (HE)
• Periodic acid-Schiff (PAS)
• Grocott

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DIAGNOSIS

• Clinical features
• Microbiology
• Histopathology
• DNA amplification
• Gaudio et al Br J Ophthalmol 200286755

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OPTIMAL MANAGEMENT 1

• low threshold of suspicion
• biopsy even when scrape is negative
• appropriate topical therapy
• ?intracameral injection
• Kaushik et al Cornea 200120715

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ANTIFUNGAL AGENTS 1

• Natamycin
• Amphotericin B
• Flucytosine
• Azoles

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AZOLES

• Clotrimazole
• Miconazole
• Econazole
• Ketoconazole
• Itraconazole
• Fluconazole
• Voriconazole?

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OPTIMAL MANAGEMENT 2

• avoidance of topical steroid?
• early surgery (up to 30)
• systemic medication

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OUTCOME

• Severity
• - delay in diagnosis
• - genus of fungus
• Treatment
• - compliance
• - toxicity
• - availability

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CONCLUSION

• FK rare in UK but ?increasing
• Outcome dictated by diagnosis, species and
  management
• Optimal treatment may include surgery, better
  medication and intracameral injection