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

To compare the demographics, clinical characteristics, and treatment outcomes of pigmented versus non-pigmented fungal corneal ulcers.

A retrospective analysis was carried out on 100 consecutive culture-proven cases of keratomycosis (pigmented [n = 50] and non-pigmented [n = 50]) who presented between Jan-2024 to Jun-2024 at the L V Prasad Eye Institute, Bhubaneswar, India.

There was no significant difference in ulcer size or presenting visual acuity between the two groups. Macroscopic pigmentation was observed in only 16% of eyes with keratitis due to pigmented fungus. Both groups responded favorably to medical therapy with similar rates of infiltrate resolution and scar formation. The final visual acuity was not significantly different between the groups. However, number of patients requiring surgical intervention was significantly more in non-pigmented group than pigmented (P = 0.03). Also, a trend towards higher frequencies of therapeutic penetrating keratoplasties and eviscerations was observed in the non-pigmented group compared to the pigmented group.

Macroscopic pigmentation was proven to be an unreliable diagnostic indicator. The requirement for surgical interventions differed significantly between two groups. These findings highlight the importance of species-specific treatment protocols and need for aggressive management of deep ulcers to improve visual outcomes.