Fusarium keratitis in Mexico.
OBJECTIVE
To describe the clinical characteristics, diagnosis, treatment, and visual outcome of 61 cases of Fusarium keratitis in Mexico.


METHODS
Retrospective, comparative study of 61 patients with clinically and culture-confirmed Fusarium keratitis, who were attended at an eye hospital in Mexico City from 1981 to 2001.


RESULTS
Fusarium solani was the main causal agent in 83.6% of cases. Trauma history was observed in 57.4% and a history of agricultural activity in 34.4%. Signs were redness (100%), epithelial defects (98.3%), superficial corneal ulcer (95.1%), anterior chamber inflammation (91.8%), and satellite infiltrates (75.4%). In 50% of cases, the treatment was topical ketoconazole 2%; in 34.2% of cases, additional topical antifungal preparations were used. A total of 77% of patients improved and 23% worsened. Conjunctival flap was indicated in 4 of 61 patients (6.5%), and 14 of 61 patients (23%) underwent penetrating keratoplasty. Two of 61 patients were treated with tectonic keratoplasty. Evisceration surgeries were practiced in 14 of 61 patients (22.9%). The final visual acuity after medical or medical/surgical therapy, was no light perception (NLP) in 19 patients (33.33%), light perception (LP) to hand movements (HM) in 18 patients (31.57%), 20/400 to 20/200 in 1 patient (1.75%), 20/150 to 20/60 in 5 patients (8.77%), and 20/40 to 20/20 in 14 patients (24.56%). Four patients were lost to follow-up.


CONCLUSIONS
Fusarium is the most common cause of fungal keratitis in Mexico. Most cases (43/54, 79.6%) improved with topical antifungal therapy (either monotherapy or combined). We suggest surgical therapy with conjunctival flap or penetrating keratoplasty in advanced cases, when there has been poor response to medical therapy or a very low final visual acuity.
Pérez-Balbuena
Ana Lilia
AL
From Cornea Service and the Laboratory of Microbiology, Dr. Luis Sánchez Bulnes Hospital, Asociación para Evitar la Ceguera en México, Coyoacán, Mexico.
Vanzzini-Rosano
Virginia
V
Valadéz-Virgen
José de Jesús
Jde J
Campos-Möller
Xavier
X
D000293:Adolescent; D000328:Adult; D000368:Aged; D000383:Agriculture; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D003320:Corneal Ulcer / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D005670:Fusarium; D006801:Humans; D007634:Keratitis / Q000382:microbiology / Q000473:pathology; D015948:Keratoplasty, Penetrating / Q000706:statistics & numerical data; D008297:Male; D008800:Mexico; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000706:statistics & numerical data; D013524:Surgical Flaps / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents