Related Experiment Video
Updated: Jun 17, 2025
Establishing a Porcine Ex Vivo Cornea Model for Studying Drug Treatments against Bacterial Keratitis
Published on: May 12, 2020
Overview of Mycotic Keratitis
Alejandro Arboleda1,2, Christopher N Ta3
1Department of Ophthalmology, University of California San Francisco, San Francisco, CA.
Abstract:
Keratomycosis is a serious corneal infection associated with high ocular morbidity that can lead to severe vision loss. It is estimated to affect more than 1 million patients annually, most commonly occurring in tropical climates, and represents a growing threat to patients worldwide. Despite aggressive medical management, fungal infections have a higher rate of perforation requiring surgical intervention compared with other infectious etiologies. Early diagnosis and appropriate treatment are keys to preserving vision and saving patients' eyes.Timely diagnosis of fungal keratitis helps minimize corneal damage and scarring and increases the likelihood of a favorable outcome. Studies have shown that correct identification of fungal infections is often delayed up to 2 to 3 weeks after initial presentation. This leads to incorrect or ineffective treatment for many patients. Diagnostic techniques explored in this study include corneal scrapings with staining and culture, visualization with in vivo confocal microscopy, molecular diagnostic techniques including polymerase chain reaction, and recently developed omics-based technologies.Treatment of fungal keratitis begins with topical antifungals. Medical management has been proven to be effective, but with limitations including poor drug penetration and low bioavailability. Cases that do not respond to topical therapy require more invasive and novel treatments to control the infection. We review the clinical trials that have shaped current practice patterns, with focus on the efficacy of topical natamycin as the primary therapy for filamentous fungal keratitis. We explore additional management strategies such as localized intrastromal and intracameral injections of antifungal medications, photodynamic therapy, and surgical intervention.
Insights
Early diagnosis and treatment are crucial for combating keratomycosis, a serious fungal eye infection affecting over a million people annually. Prompt intervention with effective antifungal therapies improves vision outcomes and prevents severe complications like corneal perforation.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Keratomycosis (fungal keratitis) is a significant cause of vision loss, affecting over 1 million individuals globally each year.
- Fungal eye infections often present challenges in diagnosis and treatment, leading to delayed care and increased risk of corneal perforation.
- Effective management hinges on early detection and appropriate antifungal strategies to preserve sight.
Purpose of the Study:
- To review current diagnostic techniques for fungal keratitis, including microscopy, molecular methods, and omics-based technologies.
- To evaluate the efficacy of various treatment modalities for fungal keratitis, focusing on topical natamycin and novel interventions.
- To provide insights into clinical trials shaping current management practices for this vision-threatening infection.
Main Methods:
- Review of clinical trials and diagnostic techniques for fungal keratitis.
- Analysis of diagnostic methods: corneal scrapings, in vivo confocal microscopy, PCR, and omics technologies.
- Assessment of treatment efficacy: topical antifungals, intrastromal/intracameral injections, photodynamic therapy, and surgery.
Main Results:
- Delayed diagnosis (2-3 weeks) is common, leading to suboptimal treatment outcomes.
- Topical antifungals are the first line of treatment, but penetration and bioavailability can be limited.
- Emerging therapies and surgical interventions are crucial for refractory cases.
Conclusions:
- Timely diagnosis and appropriate antifungal treatment are essential for favorable outcomes in fungal keratitis.
- Topical natamycin remains a key therapy for filamentous fungal keratitis, but alternative and advanced treatments are vital.
- Continued research into diagnostics and therapeutics is necessary to combat the growing threat of keratomycosis worldwide.
Related Concept Videos
01:23Skin Diseases and Disorders
Gram-positive Staphylococcus spp. and Streptococcus spp. are responsible for many of the most common skin infections. However, many...
01:25Glaucoma: Overview