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FUNGAL KERATITIS IN MAN

FUNGAL KERATITIS IN MAN. Andrew Tullo Royal Eye Hospital, Manchester. INCIDENCE OF FUNGAL KERATITIS (FK). Developed world 6 -35% of all microbial keratitis Developing world 22 - >50% Thomas PA Eye 2003;7:852. FUNGAL GROUPS. Filamentous - Aspergillus - Fusarium

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FUNGAL KERATITIS IN MAN

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  1. FUNGAL KERATITIS IN MAN Andrew Tullo Royal Eye Hospital, Manchester

  2. INCIDENCE OF FUNGAL KERATITIS (FK) • Developed world 6 -35% of all microbial keratitis • Developing world 22 - >50% Thomas PA Eye 2003;7:852

  3. FUNGAL GROUPS • Filamentous - Aspergillus - Fusarium - Dematiaceous • Yeasts - Candida Garg et al Cornea 2004;23:571

  4. DISTRIBUTION (%)

  5. FACTORS IN PATHOGENESIS • Injury, ocular surface compromise • Temperature • Wind • Humidity • Urbanisation/employment

  6. DIAGNOSIS • Clinical features (diff.diagnosis) • Microbiology • Histopathology • DNA amplification

  7. ASPERGILLUS AND CORNEAL FOREIGN BODY • 3 cases • Medical “cure” (1), surgical “cure” (2) • All required hospitalisation • All had lasting visual impairment Fahad et al Br J Ophthalmol 2004;88:847

  8. DIAGNOSIS • Clinical features • Microbiology • Histopathology • DNA amplification

  9. DIAGNOSIS • Clinical features • Microbiology • Histopathology • DNA amplification

  10. HISTOPATHOLGY • Haematoxylin and eosin (H&E) • Periodic acid-Schiff (PAS) • Grocott

  11. DIAGNOSIS • Clinical features • Microbiology • Histopathology • DNA amplification Gaudio et al Br J Ophthalmol 2002;86:755

  12. OPTIMAL MANAGEMENT 1 • low threshold of suspicion • biopsy even when scrape is negative • appropriate topical therapy • ?intracameral injection Kaushik et al Cornea 2001;20:715

  13. ANTIFUNGAL AGENTS 1 • Natamycin • Amphotericin B • Flucytosine • Azoles

  14. AZOLES • Clotrimazole • Miconazole • Econazole • Ketoconazole • Itraconazole • Fluconazole • Voriconazole?

  15. OPTIMAL MANAGEMENT 2 • avoidance of topical steroid? • early surgery (up to 30%) • systemic medication

  16. OUTCOME • Severity - delay in diagnosis - genus of fungus • Treatment - compliance - toxicity - availability

  17. CONCLUSION • FK rare in UK but ?increasing • Outcome dictated by diagnosis, species and management • Optimal treatment may include surgery, better medication and intracameral injection

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