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Pythium keratitis in South India: Incidence, clinical profile, management, and treatment recommendation
Ravula Hasika1, Prajna Lalitha2, Naveen Radhakrishnan1
1Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
Purpose:
To study the demographic profile, clinical features, treatment outcome, and ocular morbidity of microbiologically proven Pythium keratitis in South India.
Methods:
A retrospective analysis of clinical records of microbiologically proven Pythium keratitis at a tertiary eye care referral center in South India from January 2016 to November 2017 was performed. Demographic details, predisposing risk factors, microbiological investigations, clinical course, and visual outcome were analyzed.
Results:
Seventy-one patients with microbiologically proven Pythium keratitis were identified. The mean age was 44(±18.2) years with an increase in male preponderance and 50% were farmers. Duration of delay at time of presentation to the hospital was a mean of 14(±7.2) days. The visual acuity at baseline ranged from 6/6 to no light perception (median 2.1 logMAR). A combination of 5% natamycin and 1% voriconazole was given to 42% patients, and natamycin alone was given to 39.4% patients. 1% itraconazole eye drops alone was initiated in 7 (10%) patients and 3 among this group responded. Therapeutic keratoplasty (TPK) was performed in 48 (67.6%) patients. None of the primary grafts remained clear after a period of 1 month. Twenty-six eyes (54.2%) had graft reinfection and all these eyes either developed anterior staphyloma (4) or were eviscerated (3) and 13 eyes became phthisical. The remaining 22 patients who had TPK resulted in failed graft. Among these, re-grafts were performed in 6 patients, of which 5 were doing well at the last follow-up.
Conclusion:
We report a large series of patients with Pythium keratitis. Promoting early and differential diagnosis, awareness of clinicians and specific treatment options are needed for this devastating corneal disease.
Insights
Pythium keratitis, a fungal eye infection, often affects farmers in South India. Early diagnosis and specific treatments are crucial for managing this severe corneal disease and preventing vision loss.
Area of Science:
- Ophthalmology
- Medical Mycology
- Infectious Diseases
Background:
- Pythium keratitis is a rare but severe form of microbial keratitis.
- It is often associated with agricultural activities and can lead to significant vision impairment.
Purpose of the Study:
- To investigate the demographic characteristics, clinical presentation, treatment outcomes, and ocular morbidity associated with Pythium keratitis in South India.
Main Methods:
- A retrospective analysis of 71 patients with microbiologically confirmed Pythium keratitis was conducted.
- Data collected included patient demographics, risk factors, microbiological findings, treatment regimens, and visual outcomes.
Main Results:
- The study identified a mean patient age of 44 years, with a male predominance and 50% of patients being farmers.
- Delayed presentation (mean 14 days) was common, and visual acuity varied significantly.
- Therapeutic keratoplasty (TPK) was performed in 67.6% of cases, but graft reinfection and failure were high (54.2%), leading to severe ocular morbidity.
Conclusions:
- Pythium keratitis presents a significant challenge due to delayed diagnosis and treatment difficulties.
- There is a critical need for increased clinician awareness and development of targeted treatment strategies for this devastating corneal infection.
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