title: Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania.
abstract: OBJECTIVE
  To report the spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia.
  
  
  METHODS
  We reviewed the records of 24 cases of culture-positive fungal keratitis treated from January 1991 to March 1999 at Wills Eye Hospital. Risk factors, fungal identification, antifungal treatment, and outcomes were evaluated.
  
  
  RESULTS
  The study included 24 eyes (24 patients). Fourteen patients (58.3%) were female. The mean age was 59 years (range, 19-86 years). Predisposing factors included chronic ocular surface disease (41.7%), contact lens wear (29.2%), atopic disease (16.7%), topical steroid use (16.7%), and ocular trauma (8.3%). Early identification of fungal elements was achieved by staining of corneal scrapings in 18 cases (75%). Half of the cases (12 eyes) had corneal infections caused by yeast, and the other half by filamentous fungi. Candida albicans was the most commonly isolated organism (45.8%), followed by Fusarium sp (25%). Natamycin and amphotericin B were the topical antifungals most frequently used, while systemic treatment commonly used included fluconazole, ketoconazole, or itraconazole. Six patients (25%) had penetrating keratoplasty during the acute stage of infection. After a mean follow-up of nine months, 13 eyes (54.1%) had the best corrected visual acuity 20/100 or better.
  
  
  CONCLUSIONS
  In contrast to other studies from the northern United States, we found Fusarium sp the most commonly isolated filamentous fungus. In our series, C. albicans was the most frequent cause of fungal keratitis, and a past history of ocular trauma was uncommon.
authors.affiliation: Cornea Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Tanure
authors.forename: E J
authors.initials: EJ
authors.lastname: Cohen
authors.forename: S
authors.initials: S
authors.lastname: Sudesh
authors.forename: C J
authors.initials: CJ
authors.lastname: Rapuano
authors.forename: P R
authors.initials: PR
authors.lastname: Laibson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D009885:Ophthalmology / Q000706:statistics & numerical data*; D010414:Pennsylvania; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents