Elsevier

Ophthalmology

Volume 113, Issue 11, November 2006, Pages 1943-1948
Ophthalmology

Original Article
Spectrum of Fungal Keratitis in North China

https://doi.org/10.1016/j.ophtha.2006.05.035Get rights and content

Purpose

To report the epidemiological features, laboratory findings, and treatment outcomes in patients with fungal keratitis in north China.

Design

Retrospective hospital-based study.

Participants

A total of 654 patients diagnosed with fungal keratitis at the Shandong Eye Institute from January 1999 to December 2004.

Methods

The medical records of 654 inpatients (654 eyes) with fungal keratitis were reviewed retrospectively for demographic features, risk factors, seasonal variation, clinical characteristics, laboratory findings, and treatment strategy.

Main Outcome Measures

Patient history, ocular examination findings by slit-lamp biomicroscopy, laboratory findings from direct smear examination and fungal culture, and treatment protocol.

Results

Fungal keratitis constituted 61.9% of cases of severe infective keratitis among the inpatients at the Shandong Eye Institute during the 6 years. Males (60.6%) were more likely to be affected by fungal keratitis than females (39.4%). Almost one third of the patients (203) were middle aged (41–50 years old). Corneal trauma (51.4%), especially injury from plants (25.7% in all patients), was the most commonly associated risk factor. The incidence of fungal keratitis was higher in harvest seasons, including summer and autumn. An increasing tendency of incidence was noted in more recent years. Direct microscopic examination of the corneal scraping samples stained with potassium hydroxide showed positivity in 88.7% of the eyes. The fungal isolates were of Fusarium species in 437 eyes (73.3%) and Aspergillus species in 72 eyes (12.1%). Surgical interventions were performed in 604 eyes (92.4%), including therapeutic penetrating keratoplasty in 399 eyes (66.0%) and therapeutic lamellar keratoplasty (LK) in 177 eyes (29.3%). Globe integrity was preserved in 626 eyes (95.7%).

Conclusions

With Fusarium species being the most commonly isolated pathogens, fungal keratitis is the leading cause of severe infective corneal ulcers in north China. Direct microscopic examination with potassium hydroxide wet mounts proves to be a rapid, simple, inexpensive diagnostic means. Corneal transplantation continues to be the most effective approach for the treatment of severe fungal keratitis. Early surgery, especially LK, can be considered if aggressive topical therapy does not achieve early disease control.

Section snippets

Patients and Methods

In this hospital-based retrospective study, we reviewed the medical history data of 1056 patients (1056 eyes) with infective corneal ulcers (excluding 461 inpatients with viral keratitis during the corresponding period) hospitalized at the Shandong Eye Institute from January 1999 to December 2004. As one of the largest tertiary referral eye centers in north China, this institution caters to a great proportion of patients with eye diseases in Shandong Province and neighboring provinces.

Detailed

Epidemiologic Features

Of the 1056 eyes with infective corneal ulcers, 654 (61.9%) were diagnosed as fungal keratitis, 129 (12.2%) as bacterial keratitis, and 15 (1.4%) as Acanthamoeba keratitis, whereas no pathogens could be isolated in the other 258 eyes (24.5%).

Of the 654 patients with fungal keratitis, 396 (60.6%) were male, and 258 (39.4%) were female. The male-to-female ratio was 1.5:1. The age of patients ranged from 7 to 80 years (mean, 44.9±12.5). Patients ages 41 to 50 were most frequent (203 [31.0%]),

Discussion

Due to high incidence and poor responses to antifungal agents, fungal keratitis has become an important cause of visual loss in many developing countries, where a large number of the population are farm workers. Moreover, the climate is mild and humid, and malnutrition is common. All these factors predispose people to the development of fungal keratitis from minor eye trauma. Fungi reside as commensals in flora of the conjunctival sac in 3% to 28% of healthy eyes12, 13, 14 and may invade the

References (33)

  • A. Chowdhary et al.

    Spectrum of fungal keratitis in north India

    Cornea

    (2005)
  • A.K. Leck et al.

    Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis

    Br J Ophthalmol

    (2002)
  • X.G. Sun et al.

    Etiological analysis on ocular fungal infection in the period of 1989–2000

    Chin Med J (Engl)

    (2004)
  • S. Sharma et al.

    Evaluation of corneal scraping smear examination methods in the diagnosis of bacterial and fungal keratitis: a survey of eight years of laboratory experience

    Cornea

    (2002)
  • L. Xie et al.

    Clinical diagnosis of fungal keratitis by confocal microscopy

    Zhonghua Yan Ke Za Zhi

    (1999)
  • L. Xie et al.

    Lamellar keratoplasty for the treatment of fungal keratitis

    Cornea

    (2002)
  • Cited by (0)

    Manuscript no. 2005-471.

    Supported by the National Natural Science Foundation of China, Beijing, China (grant no.: 30271394); Department of Science and Technology of Shandong Province, Jinan, China (grant nos.: 2004GG2202154, 021100105); and Qingdao Municipal Science and Technology Bureau, Qingdao, China (grant no.: 02KGYSH-01).

    View full text