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 - Dematiaceous Yeasts - Candida Garg et al Cornea 2004;23:571

DISTRIBUTION (%)

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

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

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

DIAGNOSIS Clinical features Microbiology Histopathology DNA amplification

DIAGNOSIS Clinical features Microbiology Histopathology DNA amplification

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

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

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

ANTIFUNGAL AGENTS 1 Natamycin Amphotericin B Flucytosine Azoles

AZOLES Clotrimazole Miconazole Econazole Ketoconazole Itraconazole Fluconazole Voriconazole?

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

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

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