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Risk factors for treatment outcome in fungal keratitis
Prajna Lalitha1, Namperumalsamy Venkatesh Prajna, Amit Kabra
1Department of Ocular Microbiology, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamilnadu, India. lalitha@aravind.org
Purpose:
To identify risk factors at diagnosis that can serve as prognostic indicators of primary treatment failure in cases of fungal keratitis.
Design:
Prospective, nonrandomized, interventional, comparative study.
Participants:
A total of 115 consecutive patients with fungal keratitis treated at one center during a 6-month period.
Methods:
Patients with a microscopic corneal ulcer smear that was positive for fungus were enrolled and treated with 5% natamycin monotherapy according to the protocol of the hospital. Treatment responses were assessed at the end of 4 weeks. The prognostic indicators were used in a Poisson model for multiple regression analysis to estimate the relative risk of the main prognostic variables.
Main Outcome Measures:
Response of the ulcer to treatment.
Results:
Of the 115 patients analyzed in the study, 52 (45.2%) were treatment successes, 27 (23.5%) had slow-healing ulcers, and 36 (31.3%) were refractory to primary treatment. Multivariate analysis showed that the predictors of treatment failure were ulcers that exceeded 14 mm(2) (P = 0.009), the presence of hypopyon (P = 0.003), and identification of Aspergillus (P = 0.003).
Conclusion:
In patients with fungal keratitis treated with 5% natamycin monotherapy, larger ulcer size and infection with Aspergillus were predictors of a poor outcome.
Insights
Larger fungal keratitis ulcers and Aspergillus infections predict treatment failure. Early identification of these risk factors can improve patient outcomes in fungal eye infections.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Fungal keratitis is a serious eye infection.
- Primary treatment failure can lead to vision loss.
Purpose of the Study:
- To identify risk factors at diagnosis for primary treatment failure in fungal keratitis.
- To establish prognostic indicators for fungal keratitis outcomes.
Main Methods:
- Prospective study of 115 patients with fungal keratitis.
- Treatment with 5% natamycin monotherapy.
- Multivariate analysis to identify predictors of treatment failure.
Main Results:
- 45.2% treatment success, 31.3% refractory to primary treatment.
- Predictors of failure: ulcer size >14 mm², hypopyon, Aspergillus infection.
- P-values < 0.009 for all significant predictors.
Conclusions:
- Larger ulcer size and Aspergillus infection predict poor outcomes in fungal keratitis.
- These factors are crucial for guiding treatment and prognosis.
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