title: Hyphal growth patterns and recurrence of fungal keratitis after lamellar keratoplasty.
abstract: OBJECTIVE
  To evaluate growth patterns of fungal pathogens in corneas and recurrence of fungal keratitis after lamellar keratoplasty (LK).
  
  
  METHODS
  Retrospective noncomparative study.
  
  
  METHODS
  One hundred seventy-four patients (174 eyes) with fungal keratitis who underwent LK at Shandong Eye Institute from January 2000 through November 2006.
  
  
  METHODS
  Medical records of each patient were retrospectively reviewed. Hyphal growth patterns in corneas were evaluated by histopathological examination. Fungal recurrence after LK was observed during the follow-up.
  
  
  METHODS
  Pathogens, hyphal growth patterns, and postoperative fungal recurrence.
  
  
  RESULTS
  The pathogens were Fusarium (85.1%), Aspergillus (6.3%), Alternaria (4.6%), Penicillium (2.3%), and Candida (1.7%). Most Fusarium hyphae (91.2%) lay parallel to the corneal stromal lamellae, whereas most Aspergillus (90.9%) grew vertically. Recurrence of fungal keratitis was found in 15 patients (8.6%) after LK, and the pathogens were F. oxysporum (33.3%), F. solani (26.7%), F. moniliforme (13.3%), Aspergillus flavus (13.3%), Aspergillus fumigatus (6.7%), and Aspergillus terreus (6.7%). In cases of fungal recurrence, the majority of hyphae (80%) grew vertically. There was a higher recurrence rate in patients with vertically growing hyphae (46.2%) than in those with horizontally growing hyphae (2%) (chi(2) = 54.664, P<0.001), as well as in those with Aspergillus keratitis (36.4%) versus those with Fusarium keratitis (7.4%) (chi(2) = 10.031, P = 0.002). Reproducibility of the fungal recurrence rate was moderate in the patients with different hyphal growth patterns (kappa = 0.534) but poor in those with different fungal pathogens (kappa = -0.044).
  
  
  CONCLUSIONS
  Hyphal growth patterns in corneas differ not only in the same fungal genus but also in the same species. The fungal recurrence rate after LK in patients with hyphae growing horizontally is much lower than that in those with hyphae growing vertically. Growth patterns of fungal pathogens may be an important factor for fungal recurrence after LK.
authors.affiliation: State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China. lixinxie@public.qd.sd.cn
authors.forename: Lixin
authors.initials: L
authors.lastname: Xie
authors.forename: Hualei
authors.initials: H
authors.lastname: Zhai
authors.forename: Weiyun
authors.initials: W
authors.lastname: Shi
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.forename: Shiying
authors.initials: S
authors.lastname: Sun
authors.forename: Xinjie
authors.initials: X
authors.lastname: Zang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003315:Cornea / Q000382:microbiology*; D016039:Corneal Transplantation; D003320:Corneal Ulcer / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000382:microbiology*; D005260:Female; D006801:Humans; D025301:Hyphae / Q000254:growth & development*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies