Surgical outcomes in cases of contact lens-related Fusarium keratitis

To examine seven cases of contact lens-related Fusarium keratitis that resulted in therapeutic penetrating keratoplasty, to investigate which factors were associated with favorable versus poor graft outcome in this population.

Seven patients who underwent corneal transplant after contact lens-related, culture-proven Fusarium keratitis were identified through a retrospective chart review. The cases occurred between September 2005 and January 2006 at the University of Medicine and Dentistry of New Jersey and Wills Eye Hospital. All seven patients had used Bausch and Lomb's ReNu with MoistureLoc. The outcomes studied were graft status, infection recurrence, and 6-month postoperative visual acuity.

The rejection rate was 57.1% and the recurrence rate was 28.6% in this study. No eyes were lost to fungal endophthalmitis. In this population, larger ulcer size and a greater total number of medical agents used before and after penetrating keratoplasty were significantly associated with poor outcomes, namely graft rejection and poor visual acuity. In addition, it was noted that the patients who suffered recurrence of infection had both a larger median graft size and a longer median duration of postoperative antifungal use although these results did not reach statistical significance.

Larger ulcer size, larger graft size, a greater number of medical agents used, and a longer duration of postoperative antifungal therapy may be useful parameters in predicting surgical outcomes in patients with fungal keratitis. Further research is needed to validate our results and to elucidate the mechanisms behind graft rejection in the setting of fungal keratitis.