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[Multicenter Prospective Observational Study of Fungal Keratitis--Current Status of Patients' Background, Clinical
Purpose:
To investigate the current status of fungal keratitis in Japan.
Methods:
The patients with fungal keratitis were examined at 27 facilities in Japan from November 1st 2011 to October 31st 2013, concerning isolates, patient background, clinical findings, treatment and prognosis.
Results:
Out of 139 cases, 133 were diagnosed as fungal keratitis, of which fungi were isolated from 72 samples of 71 cases (yeast-like fungi 32 strains and filamentous fungi 40 strains). The corrected visual acuity at the first visit of 88 cases (66.2%) was less than 20/200 and 42 cases (31.6%) were involved with deep stromal lesions, indicating high proportion of severe cases in this study. Three months later, 56 cases (42.1%) were still under treatment, and corrected visual acuity of 57 cases (42.9%) was less than 20/200. In cases with yeast-like fungi, there were significantly more cases with past history of corneal diseases, ocular surgery including keratoplasty, and eye drops' use such as steroids than those with filamentous fungi. On the other hand, there were significantly more cases of filamentous fungi, with trauma on the onset and with intervention of previously attending doctors than those with yeast-like fungi. Logistic regression analyses revealed that contact lens wearing was a significant factor of good prognosis, and yeast-like fungi as one of poor outcome compared with no fungal isolation.
Conclusion:
Although the choice of antifungal drugs has been increasing, fungal keratitis is still severe, refractory and vision-threatening disease.
Insights
Fungal keratitis remains a severe, vision-threatening disease in Japan, often presenting with poor visual acuity and deep stromal involvement. Yeast-like fungi are associated with poorer outcomes compared to filamentous fungi, despite increasing antifungal options.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Context:
- Fungal keratitis is a significant cause of visual impairment globally.
- Understanding the epidemiology and clinical characteristics of fungal keratitis in specific regions is crucial for effective management.
- Japan has a notable incidence of fungal keratitis, necessitating regional data analysis.
Purpose:
- To investigate the current status of fungal keratitis in Japan.
- To analyze the etiological agents, patient demographics, clinical presentations, treatment strategies, and prognoses of fungal keratitis cases.
- To identify risk factors and prognostic indicators for fungal keratitis in the Japanese population.
Summary:
- A study of 139 fungal keratitis cases in Japan (2011-2013) revealed a high proportion of severe presentations with poor visual acuity and deep stromal lesions.
- Fungi were isolated in 71 cases, with both yeast-like and filamentous fungi identified.
- Contact lens wear was associated with a better prognosis, while yeast-like fungal infections indicated a poorer outcome.
Impact:
- The findings highlight that fungal keratitis is a severe and refractory condition in Japan, despite advancements in antifungal treatments.
- Identifying specific risk factors and etiological agents can inform targeted prevention and treatment strategies.
- This research contributes to the understanding of fungal keratitis epidemiology and clinical management in East Asia.
