Keratitis due to pigmented vs. Nonpigmented fungi: Clinical features and outcome

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Fungal corneal ulcers (keratomycosis) present diagnostic challenges.
• Distinguishing between pigmented and non-pigmented fungal keratitis is crucial for treatment planning.

Purpose of the Study:

• To compare demographics, clinical features, and treatment outcomes of pigmented versus non-pigmented fungal corneal ulcers.
• To evaluate the diagnostic reliability of macroscopic pigmentation in fungal keratitis.

Main Methods:

• Retrospective analysis of 100 culture-proven keratomycosis cases (50 pigmented, 50 non-pigmented).
• Data collected on demographics, clinical characteristics, ulcer size, visual acuity, and treatment outcomes.
• Comparison of medical and surgical intervention rates between the two groups.

Main Results:

• No significant difference in ulcer size or presenting visual acuity between pigmented and non-pigmented fungal keratitis groups.
• Macroscopic pigmentation was present in only 16% of eyes with pigmented fungal keratitis.
• Similar rates of infiltrate resolution and scar formation with medical therapy; however, non-pigmented ulcers required significantly more surgical intervention (P=0.03).

Conclusions:

• Macroscopic pigmentation is an unreliable indicator for diagnosing fungal keratitis.
• Non-pigmented fungal keratitis cases had a higher need for surgical interventions, including penetrating keratoplasty and evisceration.
• Emphasizes the need for species-specific treatment protocols and aggressive management of deep fungal ulcers to optimize visual outcomes.