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Management of corneal fungal infections

Poster Details


First Author: D.Borroni LATVIA

Co Author(s): K. Bajracharya   A. Gautam                 

Abstract Details

Purpose:

Corneal ulcer due to Fungal Infection is a major cause of blindness in agricultural areas of Nepal. We evaluated the characteristics of 158 patients with fungal keratitis at Lumbini Eye Institute (Nepal) and its medical treatments.

Setting:

Riga Stradins University

Methods:

First diagnosis of fungal infection was performed to slit-lamp examination plus Potassium Hydroxide (KOH) procedure placing specimiens in a 15% KOH solution (15g KOH, glycerol 20ml, distilled water 80ml). Antifungal drops were used every half to one hourly initially and tapered as per the clinical response. Natamycin 5% and Amphotericin B 0.15% were the first choice of treatment. Other drops used in selective cases were topical 1% voriconazole, topical 2% econazole, topical 1% itraconazole, topical 2% fluconazole. Surface debridement was considered in 47 cases. Atropine and FANS (Diclofenac) were integrated in the management.

Results:

Fungal infections of the cornea were frequently caused by Fusarium, Aspergillus, Curvularia, and Candida. Trauma was the most important predisposing cause 128/158 (81,01%). Surface debridement helped to reduce load of infection and enhanced drug penetration. Response to treatment in fungal infections is very slow and complete resolution often required 4-8 weeks of treatment.

Conclusions:

Natamycin and amphotericin B were the most used drugs for fungal keratitis who showed good clinical results. Voriconazole showed effectiveness and security and it may be the drug of choice in optimal conditions for its better ocular penetration and wider coverage but the high price per unit pone difficulties in general applications. Fluconazole has high corneal penetration and reaches therapeutic corneal levels when given orally. Its clinical role in filamentous fungal keratitis is yet to be precisely defined; however, it could be considered in patients with deep fungal keratitis. Metagenomic NGS (Next-Generation Sequencing) studies will be performed in next months.

Financial Disclosure:

None

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