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Fungal Keratitis in Pittsburgh: Clinical Features, Risk Factors, Treatment, and Outcomes
Sarah Atta1, Alex Mammen2, Deepinder K. Dhaliwal2, Robert M. Q. Shanks2, Regis P. Kowalski2, Vishal Jhanji2
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 2The Charles T. Campbell Ophthalmic Microbiology Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Purpose: Fungal keratitis is an important cause of ocular morbidity that can be challenging to diagnose and treat. We evaluated the clinical presentation, risk factors, management, and outcomes of fungal keratitis cases in Pittsburgh, Pennsylvania.
Methods: 28 cases (28 eyes) of fungal keratitis diagnosed and treated at the University of Pittsburgh Medical Center between 2015 and 2021 were identified and reviewed for clinical and microbiological characteristics.
Results: Average age at presentation was 56.00+13.86 years and average symptom duration prior to presentation was 24.11+25.64 days. Prevalent ocular risk factors included contact lens use (67.86%), recent ocular trauma/abrasion (42.86%), and history of ocular surgery (42.86%). Average presenting visual acuity (VA) was 1.66+1.69 LogMAR. About half presented with a central ulcer (42.86%), large infiltrate (8.27+7.64 mm2), corneal thinning (50.00%), and hypopyon (32.14%). Majority of isolated fungal species were filamentous fungi (75.00%). Most common antifungal medications included topical voriconazole (71.43%) and natamycin (53.57%) drops and oral voriconazole (64.29%). Adjunctive treatment was required in a large proportion of cases (78.57%), with surgical management in 32.14% cases and enucleation in one case. Corneal epithelial effect resolution occurred in 55.57+45.89 days, and final VA improved to 0.94±0.92 LogMAR. Features significantly associated with poor final visual outcomes included poor initial VA (p<0.001) and larger epithelial defect size (p=0.002).
Conclusions: Fungal keratitis was commonly caused by filamentous fungi, in contrast to previous studies in the northeast region. Contact lens use and recent ocular trauma or abrasion were frequent risk factors, and antifungal management most often consisted of topical and oral voriconazole.
Disclosure: N
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