Clinical and microbiological profile of Candida keratitis: A retrospective study from South India

Candida keratitis is an uncommon but potentially vision-threatening fungal infection of the cornea. The incidence is dramatically increasing in tropical regions, especially among patients with prior corneal transplantation, prolonged steroid use and ocular surface disease.

To determine the epidemiology, risk factors, management and outcomes of Candida keratitis in South India.

A retrospective analysis of clinical records of microbiologically confirmed cases of Candida keratitis at a tertiary eye hospital in South India between January 2017 and January 2024 was performed. Data regarding patient demographics, predisposing risk factors, microbiological findings and details of both medical and surgical management were collected. Descriptive statistics, including frequencies, percentages and means were used to analyze demographic and clinical variables.

Seventeen cases (median age: 66 years) were identified. Major risk factors were topical steroid use (41.2%) and corneal transplantation (35.2%), with ocular surface diseases and trauma accounting for 17.6% each, respectively. Visual acuity at presentation was <5/60 in 88.2% of cases. Candida parapsilosis was the most commonly isolated species (41.2%), followed by Candida albicans (35.3%), Candida tropicalis (17.6%) and Trichomonascus ciferrii (Candida ciferrii) (5.9%). Medical management most commonly included topical amphotericin B, itraconazole, natamycin and voriconazole. Seven patients developed corneal scarring, two patients had corneal perforation and were managed with a bandage contact lens and therapeutic keratoplasty, one patient had graft melt leading to phthisis, and one patient progressed to panophthalmitis necessitating evisceration.

The rising incidence of Candida keratitis in tropical regions presents a clinical challenge, primarily affecting immunosuppressed patients and those with ocular surgery, requiring prompt intervention to improve outcomes.