Monotherapy or combined treatment effective in treating fungal keratitis

Cornea. 2009;28(6):626-630.

More than three-quarters of Fusarium fungal keratitis cases improved with topical antifungal therapy alone or in conjunction with other treatments, according to a study conducted in Mexico.

"We suggest surgical therapy with conjunctiva flap or penetrating keratoplasty in advanced cases, when there has been poor response to medical therapy or a very low final visual acuity," the study authors said.

The retrospective, comparative study included 61 patients with clinically and culture-confirmed Fusarium keratitis who were treated between 1981 and 2001. Forty-eight patients were men, with an average age of 41.5 years; 13 patients were women, with an average age of 40 years. A history of ocular trauma was seen in 57.4% of cases; 34.4% of cases had a history of agriculture activity.

Fifty-four patients followed medical treatment. Four patients chose to halt treatment; three patients underwent evisceration surgery and did not receive antifungal treatment.

Monotherapy was administered to 44 patients, and 10 patients underwent combined antifungal therapy. Twenty-eight severe cases underwent monotherapy or combined topical antifungal treatment and surgery.

Study data showed that 77.7% of patients were treated successfully with medical treatment alone or in conjunction with surgery. Natamycin was indicated in five cases; successful treatment was achieved in four of those cases. Fungal keratitis resolved in four cases treated with miconazole.

Successful treatment correlated with small wound size and a short time interval between injury and medical treatment, the authors said.