Clinical experience in managing Fusarium solani keratitis
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1Department of Ophthalmology, Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. hclinn@adm.cgmh.org.tw
Abstract:
Fusarium solani keratitis is a rare ocular infectious disease. The clinical characteristics and treatment methods of 18 patients with culture proven F. solani keratitis between July 1997 and December 2003 and with a follow-up period of more than 4 months were analysed retrospectively. The patients were divided into two groups based on the severity of keratitis. Group A (n = 13) displayed non-severe keratitis and were treated with debridement, lamellar keratectomy and antifungal medication. Group B (n = 5) displayed severe keratomycosis and were treated with lamellar keratectomy combined with amniotic membrane transplantation (AMT) and antifungal medication. In group A, wound healing did not interfere with the integrity of the anterior chamber. The mean re-epithelialisation time was 12.67 days (range: 5-21 days). All patients were free of major immediate postoperative complications. In group B, AMT preserved the anterior chamber integrity in two cases, but failed to do so in the other three cases. Therapeutic patch grafts were required in these three cases. Non-severe F. solani keratitis is best treated with superficial keratectomy. Timely AMT combined with lamellar keratectomy appears to be an adjuvant therapy for severe keratomycosis and avoiding emergent therapeutic penetrating keratoplasty. However, AMT was effective in cases involving non-suppurative Fusarium keratitis.
Insights
Superficial keratectomy effectively treats non-severe Fusarium solani keratitis. For severe cases, amniotic membrane transplantation (AMT) combined with lamellar keratectomy may help preserve anterior chamber integrity.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Fusarium solani keratitis is a rare but serious ocular infection.
- Early diagnosis and appropriate treatment are crucial for managing this condition.
Purpose of the Study:
- To analyze the clinical characteristics and treatment outcomes of Fusarium solani keratitis.
- To compare treatment strategies for non-severe versus severe cases of fungal keratitis.
Main Methods:
- Retrospective analysis of 18 patients with culture-proven Fusarium solani keratitis (July 1997-December 2003).
- Patients divided into non-severe (Group A, n=13) and severe (Group B, n=5) keratitis groups.
- Group A treated with debridement, lamellar keratectomy, and antifungals; Group B with lamellar keratectomy, amniotic membrane transplantation (AMT), and antifungals.
Main Results:
- Non-severe keratitis (Group A) showed good wound healing and re-epithelialization (mean 12.67 days) without anterior chamber complications.
- Severe keratitis (Group B) showed variable outcomes with AMT; it preserved anterior chamber integrity in 2/5 cases, while 3/5 required therapeutic patch grafts.
- AMT was more effective in non-suppurative fungal keratitis cases.
Conclusions:
- Superficial keratectomy is recommended for non-severe Fusarium solani keratitis.
- AMT combined with lamellar keratectomy can be an adjuvant therapy for severe fungal keratitis, potentially avoiding penetrating keratoplasty.
- AMT's efficacy in severe cases is dependent on the suppurative nature of the keratitis.
