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Fungal keratitis: microbiological evaluation and medical treatment with topical drugs

Poster Details

First Author: D.Borroni LATVIA

Co Author(s):    G. Midena   K. Bajracharya   I. Markevica   S. Patel   A. Gautam   I. Orube

Abstract Details

Purpose:

Fungal Keratitis is one of the major blinding cause in agricultural areas of Nepal, usually associated with vegetal trauma. We evaluate the characteristics of 158 patients with fungal keratitis diagnosed at Lumbini Eye Institute (Nepal) and his medical treatments.

Setting:

Riga Stradins University, Lativa

Methods:

The first diagnosis of fungal keratitis was done in slit-lamp examination plus Potassium Hydroxide (KOH) procedure placing specimiens in a 15% KOH solution (15g KOH, Glycerol 20ml, distilled water 80ml). Antifungal drops was 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 was topical 1% voriconazole, topical 2% econazole, topical 1% itraconazole , topical 2% fluconazole. Surface debridement was considered in some cases. Atropine and FANS (Diclofenac) were integrated in the management.

Results:

Fungal infections of the cornea was frequently caused by species of 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. Visual acuity was worse than 1/10 in 89/158 (56,32%) of patients at presentation. Final visual acuity was 4/10 or better in 122/158 (77,22%) of patients treated. In the acute phase surgical intervention was necessary in 21/158 (13,29%) of patients.

Conclusions:

Natamycin and Amphotericin B was the most used drugs for fungal keratitis who showed good clinical results. In multiple fungal infections Voriconazole showed effectiveness and security. It may be the drug of choice in optimal conditions for its better ocular penetration and wider coverage. The high price pone difficulties in general application. 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 but it could be considered in patients with deep fungal keratitis. New studies will be performed in Metagenomic with Next-Generation Sequencing (NGS). FINANCIAL DISCLOUSRE: NONE

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