Issue: June 2016
June 28, 2016
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Early diagnosis, treatment of fungal keratitis key to preserving vision

Issue: June 2016
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Early identification and treatment are key to preserving vision in patients with fungal keratitis resulting from Exserohilum infection, according to a study.

Perspective from Eduardo C. Alfonso, MD

In the retrospective, noncomparative observational study, records of 1,542 cases with keratomycosis were culled from the cornea service at the Aravind Eye Hospital in Tamil Nadu, India. Of these cases, 47 were caused by Exserohilum.

All patients underwent corneal scraping, were evaluated for significant culture growth and then received natamycin 5% topical treatment. Average time of first hospital visit after onset of symptoms was 6.2 days, and trauma was present in 38 cases. Results showed that 89.4% of cases responded well to topical treatment, therapeutic penetrating keratoplasty was necessary in 8.5% of cases, and 2.1% of cases progressed to endophthalmitis and required evisceration.

“Owing to rarity of the infection, there is no clinical study regarding the treatment protocol. However, case reports had shown that the infiltrate responds well to topical antifungals such as natamycin and itraconazole,” the study authors wrote.

Mean best corrected visual acuity improved from preoperative 0.89 logMAR to postoperative 0.77 logMAR.

“The patient will usually maintain good vision if the infection is diagnosed and treated early. The need for therapeutic PK in these patients seems to be less than that reported in other common fungal infections,” the authors wrote. – by Kate Sherrer

Disclosure: The authors report no relevant financial disclosures.