Management of Filamentous Fungal Keratitis: A Pragmatic Approach

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Filamentous fungal keratitis (FK) presents significant treatment challenges.
• Topical natamycin 5% is the standard first-line therapy, but treatment failures and corneal perforation can occur.
• Effectiveness and availability of current topical antifungals are often limited.

Purpose of the Study:

• To review current treatment options for filamentous fungal keratitis.
• To evaluate the evidence supporting different therapeutic strategies.
• To provide a pragmatic management guide for clinicians, particularly in resource-limited tropical areas.

Main Methods:

• Literature review of clinical trials and therapeutic strategies for fungal keratitis.
• Analysis of evidence for topical, surgical, and alternative antifungal treatments.
• Synthesis of information to propose a practical management approach.

Main Results:

• Natamycin 5% is a primary treatment, but alternatives like voriconazole, chlorhexidine, amphotericin B, and econazole exist.
• Severe cases or perforation may necessitate therapeutic penetrating keratoplasty.
• Intrastromal or intracameral antifungal injections are alternative strategies.

Conclusions:

• There is a lack of clear treatment guidelines and supporting evidence for fungal keratitis management.
• A pragmatic approach is needed, especially in tropical, low-resource settings where FK is prevalent.
• This review aims to guide clinicians in managing FK effectively.