Fungal keratitis in London: microbiological and clinical evaluation.
OBJECTIVE
To review cases of culture-positive fungal keratitis seen at Moorfields Eye Hospital over a 13-year period to January 2007.


METHODS
Isolates were identified retrospectively from laboratory reports. The clinical records were reviewed. The fungal type, risk factors for infection, in vitro sensitivity, and clinical outcome were recorded.


RESULTS
There were 66 isolates from 65 patients (men, 53.8%). Forty (60.6%) of the isolates were subspecies of Candida. The average interval from the onset of keratitis to confirmation of fungal infection was 3.4 weeks (median, 1.0 week; range, 0-16 weeks). Prior ocular surface disease (OSD) or a penetrating keratoplasty (PK) was present in 38 (97.4%) patients with Candida infection, and 29 (74.4%) patients with Candida infection were using topical steroid at the time of diagnosis. The principal risk factors for filamentary fungal infection were trauma (8 cases, 30.8%) or cosmetic contact lens wear (8 cases, 30.8%), with OSD or a prior PK each present in 5 (19.2%) cases. The difference in the proportions of risk factors between the 2 fungal groups was statistically significant (P < 0.000). The visual outcome was similar between groups, and at final review, 27 (41.5%) eyes had a visual acuity of < or = 1/60 and 3 (4.6%) eyes were eviscerated. In vitro sensitivity testing showed full or part sensitivity in 100% of 55 isolates tested against econazole, 87.9% of 58 isolates tested against amphotericin, 75% of 40 isolates tested against itraconazole, and 100% of 20 isolates tested against voriconazole.


CONCLUSIONS
Candida was the principal isolate, usually from eyes with OSD or a prior PK treated with topical steroids.
Galarreta
David J
DJ
Moorfields Eye Hospital, London, UK.
Tuft
Stephen J
SJ
Ramsay
Andrew
A
Dart
John K G
JK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D008131:London; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors
D000935:Antifungal Agents