Clinical Characteristics and Outcome Predictors in Microbiologically Proven Mycotic Keratitis
NC17-NC21
Correspondence
Dr. Bini Sukumaran Thulasi,
Pallavam, PJRRA G 10, Pothujanam Road, G Lane, Kumarapuram,
Medical College PO, Trivandrum-695011, Kerala, India.
E-mail: binist96@gmail.com
Introduction: Mycotic keratitis is a major cause of monocular blindness in tropical and subtropical climates. The difficulty to differentiate mycotic keratitis (fungal keratitis) from other causes, limited availability of antifungal agents, their poor ocular penetration and indolent course of the disease lead to significant ocular complications and vision loss.
Aim: To analyse the typical presenting clinical characteristics which predict the final visual outcome in microbiologically proven mycotic keratitis over two years in a tertiary eye care centre of South Kerala, India.
Materials and Methods: The present study was a retrospective study, conducted on 165 eyes of 165 patients treated for culture proven mycotic keratitis in the Regional Institute of Ophthalmology, South Kerala, India, from August 2018 to July 2020. Best Corrected Visual Acuity (BCVA), detailed history including history of injury and systemic diseases were noted. Treatment outcome was measured as BCVA at the end of three months. The association between age, sex, presenting features like size, depth, margins and colour of the keratitis and the final BCVA were assessed by linear regression analysis.
Results: Among 165 eyes, 90 (54.6%) had a history of injury in the affected eye. The majority of the keratitis had a size of 2-6 mm in 150 (90.9%), peripheral in location in 107 (64.8%) and involvement up to anterior 2/3rd of the stroma in 93 (56.4%). Of 165, 112 (67.9%) of the ulcers had a greyish white or pigmented colour, 118 (71.5%) had dry texture and 115 (69.7%) had feathery margins. Raised exudates were present in 99 (60%) patients, satellite lesions in 29 (17.6%), immune ring in 6 (3.6%), endothelial plaque in 20 (12.1%) and hypopyon in 40 (24.2%) at the time of diagnosis. The important predictors of final BCVA at three months were the larger size of the ulcer, increase in depth, central location, presence of hypopyon and poor vision at presentation.
Conclusion: Small superficial keratitis with good vision at presentation had a better final BCVA. Dry texture and feathery edges were seen more frequently in fungal keratitis. Large, deep, central keratitis and poor vision at presentation are associated with worse final visual outcome after treatment.