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Comparative study on the incidence and outcomes of pigmented versus non pigmented keratomycosis
Sabyasachi Sengupta1, Sanjeevani Rajan, Padmati Ravindranath Reddy
1Department of Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. drsunny1980@gmail.com
Purpose:
To determine the incidence, outcomes and establish factors determining visual prognosis of keratomycosis due to pigmented fungi in comparison with nonpigmented fungi.
Materials And Methods:
All culture-proven cases of fungal keratitis from January 2006 to August 2008 were drawn from a computerized database and cases with adequate documentation were analyzed for predisposing factors, clinical characteristics, microbiology and treatment methods. Outcomes of keratitis due to pigmented and nonpigmented fungi were compared using t-test and χ2 test.
Results:
Of 373 cases of keratomycosis during the study period, pigmented fungi were etiological agents in 117 eyes (31.3%) and nonpigmented fungi in 256 eyes (68.7%). Eyes with nonpigmented keratitis had significantly larger ulcers (14.96 mm 2 ) and poorer vision (1.42 logMAR) at presentation compared to those with keratomycosis due to pigmented fungi (P=0.01). The characteristic macroscopic pigmentation was seen in only 14.5% in the pigmented keratitis group. Both groups responded favorably to medical therapy (78.1% vs. 69.1%) with scar formation (P=0.32) and showed a significant improvement in mean visual acuity compared with that at presentation (P<0.01). Visual improvement in terms of line gainers and losers in the subgroup of eyes that experienced healing was also similar. Location of the ulcer was the only factor that had significant predictive value for visual outcome (P=0.021).
Conclusion:
Incidence of keratomycosis due to pigmented fungi may be increasing as compared to previous data. These eyes have similar response to medical therapy and similar visual outcome compared to nonpigmented keratitis. Central ulcers have a poor visual outcome.
Insights
The incidence of fungal keratitis caused by pigmented fungi may be rising. Despite differences in ulcer size, both pigmented and nonpigmented fungal keratitis show similar treatment responses and visual outcomes, with ulcer location being key to prognosis.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal keratitis (keratomycosis) is a significant cause of visual impairment globally.
- Pigmented fungi are increasingly recognized as etiological agents in fungal keratitis.
Purpose of the Study:
- To compare the incidence, clinical characteristics, and visual outcomes of keratomycosis caused by pigmented versus nonpigmented fungi.
- To identify factors influencing the visual prognosis in fungal keratitis.
Main Methods:
- A retrospective analysis of 373 culture-proven fungal keratitis cases from January 2006 to August 2008.
- Comparison of clinical data, microbiological findings, and treatment outcomes between eyes infected with pigmented and nonpigmented fungi using statistical tests.
Main Results:
- Pigmented fungi accounted for 31.3% of keratomycosis cases.
- Eyes with nonpigmented fungal keratitis presented with larger ulcers and poorer visual acuity compared to those with pigmented fungi (P=0.01).
- Both groups demonstrated favorable responses to medical therapy and similar visual outcomes, with ulcer location being a significant predictor of visual prognosis (P=0.021).
Conclusions:
- The incidence of keratomycosis due to pigmented fungi may be increasing.
- Pigmented fungal keratitis exhibits similar therapeutic responses and visual outcomes to nonpigmented fungal keratitis.
- Central corneal ulcers are associated with a poor visual outcome.
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