1. Management of Mycotic Keratitis
ID : 325
Chief author: Sudesh Kumar Arya
Co-authors: Anamika Garg
Jagdish Chander
Archana Malik
Sunandan Sood
Department of Ophthalmology and Microbiology
Government Medical College & Hospital Chandigarh,India
The Authors have no financial interest

2. Introduction Aim of the Study
Infective keratitis is a suppurative infection of cornea which may be
associated with epithelial defects and / or signs of inflammation.
Fungi - responsible for nearly 1/3rd of infective keratitis
Mycotic keratitis remains a diagnostic and therapeutic challenge to the
ophthalmologist. Difficulties are related to establishing a clinical diagnosis, isolating the etiologic fungal organism in the laboratory, and treating the keratitis effectively with topical antifungal agents or by surgery.
Aim of the Study
To find out demographic profile, type of intervention and final outcome of mycotic keratitis in a tertiary care centre.
Introduction

3. Materials and Methods
Retrospective analysis of case records of 82 eyes of 82 patients from 2004 – 2009 having mycotic keratitis was done.
Exclusion criteria:
Proven case of bacterial or viral keratitis
Mixed corneal ulcer

4. Materials and Methods cont…
Demographic profile of patient
Relevant history (Predisposing factor)
Grading of ulcer ( size of ulcer, size of corneal infiltrates, scleral involvement, size of perforation if any)
Microbiological data ( Gram stain, KOH stain, Culture sensitivity for bacteria and fungus )
Type of intervention done ( Medical treatment with antifungals or mixed treatment, Glue with BCL, TPK, any other like AMT, Cyclocryotherapy, Intracameral or intrastromal Amphotericin B )
Duration of Medical treatment and number of surgical interventions

5. Observation and Results
82 patients included
Age years (Mean age yrs)
61 males, 21 females (M:F – 2.9 : 1)
75.6% from rural background

6. Various Types of Mycotic Keratitis
Fungal plaque with hypopyon
Feathery margins
Infilterates with pigmentation
Corneal abscess

7. Predisposing factors

8. Type of Interventions

9. Clear Grafts in Mycotic Keratitis

10. Results cont…
KOH positivity was present in 25 patients (incidence 20%).
Culture positivity for fungus was present in 18 patients
( incidence 14.76%).
45% of the cases of mycotic keratitis eventually needed TPK.
9.7% of the patients needed other interventions like intracameral Amphotericin B (4.8% cases), AMT (3.7% cases) and Intrastromal Amphotericin B (1.2% cases) in addition to medical treatment or TPK.

11. Discussion
25%-35% of cases of fungal keratitis require performance of a TPK to maintain ocular integrity. (Cornea 2002)
While our study showed that upto 45% of the cases eventually need TPK.
Stage at which PKP was done :
Indian Western GMCH
Grade 3 (5-7mm) % % %
Grade 4 (7-10mm) 75% % %
Grade 5 (Tot.invl.) 10% %

12. Conclusions
Mycotic keratitis is a preventable cause of corneal blindness.
Prompt clinical diagnosis aided with Microbiological support is vital for success of Medical Therapy
Surgical intervention is one of the most important modalities for salvaging the eye in mycotic keratitis.
Early surgical intervention is advocated if patient is not responding to treatment.
Predisposed persons should be educated for proper safety measures