Trends in fungal keratitis in the United States, 2001 to 2007.
OBJECTIVE
Fungal keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium keratitis outbreak raised questions regarding the background rate of Fusarium-related keratitis and other fungal keratitis in this population.


METHODS
Retrospective, multicenter case series.


METHODS
Six hundred ninety-five cases of fungal keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007.


METHODS
Ten tertiary care centers in the United States performed a retrospective review of culture-positive fungal keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research.


METHODS
Quarterly number of fungal keratitis cases and fungal species.


RESULTS
We identified 695 fungal keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 (P < 0.0001).


CONCLUSIONS
The quarterly number of Fusarium fungal keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous fungal keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear.
Gower
Emily W
EW
Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland 21287, USA. egower1@jhmi.edu
Keay
Lisa J
LJ
Oechsler
Rafael A
RA
Iovieno
Alfonso
A
Alfonso
Eduardo C
EC
Jones
Dan B
DB
Colby
Kathryn
K
Tuli
Sonal S
SS
Patel
Seema R
SR
Lee
Salena M
SM
Irvine
John
J
Stulting
R Doyle
RD
Mauger
Thomas F
TF
Schein
Oliver D
OD
D003261:Contact Lenses / Q000382:microbiology*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology