title: Candida keratitis:  emerging problem in India.
abstract: OBJECTIVE
  To determine the epidemiological characteristics and outcome of Candida keratitis in a Cornea Care Unit of Kolkata-based tertiary eye hospital.
  
  
  METHODS
  A retrospective, noncomparative, observational case series involving patients of culture-proven fungal keratitis from January 2008 to December 2008. A total of 85 cases of culture-proven fungal keratitis were identified. Of these, 16 cases were caused by Candida sp and selected for the study. The records were analyzed for demographics, risk factors, mode of management (medical or surgical), indication of surgical therapy, and the response to treatment with final outcome. Medical therapy consisted of topical amphotericin B with or without intracameral application after obtaining culture reports. Surgical therapy included application of tissue adhesive with bandage contact lens and therapeutic keratoplasty.
  
  
  RESULTS
  All cases of Candida keratitis were caused by Candida albicans accounting for 16 cases [18.81%; 95% confidence interval (CI), 11.8-28.5] of total culture-positive fungal keratitis. We found postsurgical steroid therapy in 8 cases as most important association, followed by diabetes and trauma (4 cases each) as next common comorbidities. All patients required therapeutic keratoplasty. Surgical indications were corneal melt in 10 cases (62.5%; 95% CI, 38.5-81.6), extension up to limbus in 2 cases (12.5%; 95% CI, 12.2-37.2) and nonresponse with worsening in 4 cases (25%; 95% CI, 19.7-49.9). Final outcome consists of phthisis bulbi in 3 cases (18.8%; 95% CI, 5.8-43.8), failed graft in 7 cases (43.7%; 95% CI, 23-66.8), and clear graft in 6 cases (37.5%; 95% CI, 18.4-61.5).
  
  
  CONCLUSIONS
  Candida is a new concern in developing countries like India. We are concerned about the poorer outcome, probably resulting from our unpreparedness and failure of medical therapy leading to more complication and requiring surgical intervention in higher numbers.
authors.affiliation: Cornea and Ocular Surface Disease Clinic, Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India. jayansu@hotmail.com
authors.forename: Jayangshu
authors.initials: J
authors.lastname: Sengupta
authors.forename: Archana
authors.initials: A
authors.lastname: Khetan
authors.forename: Suman
authors.initials: S
authors.lastname: Saha
authors.forename: Debdulal
authors.initials: D
authors.lastname: Banerjee
authors.forename: Nibaran
authors.initials: N
authors.lastname: Gangopadhyay
authors.forename: Dipanjan
authors.initials: D
authors.lastname: Pal
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D003261:Contact Lenses; D003320:Corneal Ulcer / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D003646:Debridement; D015821:Eye Infections, Fungal / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B