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FUNGAL KERATITIS IN MAN

This study delves into the incidence, fungal groups, distribution, pathogenesis factors, diagnosis methods, optimal management strategies, antifungal agents, and outcomes of fungal keratitis. It discusses clinical features, microbiology, histopathology, and DNA amplification techniques in diagnosing and treating this condition.

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FUNGAL KERATITIS IN MAN

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  1. FUNGAL KERATITIS IN MAN Andrew Tullo Royal Eye Hospital, Manchester

  2. INCIDENCE OF FUNGAL KERATITIS (FK) • Developed world 6 -35% of all microbial keratitis • Developing world 22 - >50% Thomas PA Eye 2003;7:852

  3. FUNGAL GROUPS • Filamentous - Aspergillus - Fusarium - Dematiaceous • Yeasts - Candida Garg et al Cornea 2004;23:571

  4. DISTRIBUTION (%)

  5. FACTORS IN PATHOGENESIS • Injury, ocular surface compromise • Temperature • Wind • Humidity • Urbanisation/employment

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

  7. 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 2004;88:847

  8. DIAGNOSIS • Clinical features • Microbiology • Histopathology • DNA amplification

  9. DIAGNOSIS • Clinical features • Microbiology • Histopathology • DNA amplification

  10. HISTOPATHOLGY • Haematoxylin and eosin (H&E) • Periodic acid-Schiff (PAS) • Grocott

  11. DIAGNOSIS • Clinical features • Microbiology • Histopathology • DNA amplification Gaudio et al Br J Ophthalmol 2002;86:755

  12. OPTIMAL MANAGEMENT 1 • low threshold of suspicion • biopsy even when scrape is negative • appropriate topical therapy • ?intracameral injection Kaushik et al Cornea 2001;20:715

  13. ANTIFUNGAL AGENTS 1 • Natamycin • Amphotericin B • Flucytosine • Azoles

  14. AZOLES • Clotrimazole • Miconazole • Econazole • Ketoconazole • Itraconazole • Fluconazole • Voriconazole?

  15. OPTIMAL MANAGEMENT 2 • avoidance of topical steroid? • early surgery (up to 30%) • systemic medication

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

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

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