A 5-year review of fungal keratitis in Oklahoma

To evaluate demographics, risk factors, clinical characteristics, and visual outcomes of fungal keratitis (FK) in Oklahoma over 5 years and identify factors linked to poor outcomes.

A retrospective chart review was conducted at the Dean McGee Eye Institute (University of Oklahoma) from January 2019 to February 2024, identifying 103 cases of FK among 1213 corneal ulcer patients. Poor outcomes were defined as final best corrected visual acuity (BCVA) ≤20/70 or need for surgery. Statistical comparisons were performed using the Chi-square test, Wilcoxon rank-sum test, and multivariate logistic and linear regression analyses.

Overall, 42/103 (40.8%) of patients had poor outcomes. Mold was the most common etiology (74.8%). Topical steroid use (odds ratio 3.57, P = 0.0025) and poor contact lens (CL) hygiene (P = 0.027) were both independently associated with worse outcomes. However, CL users had a better final BCVA than non-users (P = 0.0138), possibly due to earlier presentation or less severe disease. Intrastromal antifungal injections and scleral lenses resulted in clinically significant mean VA improvements of 7.4 and 4 lines (logMAR-converted), respectively.

The epidemiologic patterns observed in this geographic region of the United States, a mold-predominant environment with frequent steroid misuse and CL-associated disease, highlight the importance of early diagnosis, risk-factor modification, and ready access to adjunctive therapies. As FK incidence continues to rise in similar climates, these lessons from our regional cohort may help refine triage pathways and inform treatment approaches to reduce preventable vision loss.