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Purpose <p>To evaluate the clinical course, factors contributing to healing, and outcomes of medically treated dematiaceous fungal keratitis (DFK) at a rural secondary eye care center in North India.</p> Methods <p>This retrospective, electronic medical record-based study was conducted over one year at a secondary care center. Patients of all age groups with culture-proven DFK who completed follow-up until corneal healing were included. Demographic, clinical, and microbiological data were analyzed. All patients received therapeutic debridement and natamycin monotherapy. Voriconazole was added in non-responders, and oral antifungals were used for corneal melt or posterior segment involvement. Cases requiring therapeutic keratoplasty (TPK) or evisceration were classified as poor outcomes.</p> Results <p>Hundred and eight eyes were included in the study. The mean age was 43.2 years, with 78.7% males. Trauma, most commonly from sugarcane leaves, was reported in 80.6%. Ulcers were mild in 50%, moderate in 39.8%, and severe in 10.2%. Half were small in size; 89.8% were superficial, while 5.6% showed full-thickness involvement. Neurotrophic-like defects were seen in 48.5% and significantly associated with ulcer size (<i>p</i> = 0.004). Healing occurred within 2 weeks in 44.5% and within 4 weeks in 33.7%. Delayed healing (21.8%) correlated with larger, deeper ulcers, hypopyon, and neurotrophic-like defects. TPK/evisceration (12%) was significantly associated with prior steroid use, vascularization, hypopyon, and corneal melt (<i>p</i> &lt; 0.05).</p> Conclusion <p>Despite prolonged healing, DFK has a high resolution rate with appropriate medical therapy, minor procedures, and complete debridement. Poor prognostic factors include large and deep infiltrates, hypopyon, and prior steroid use.</p>

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Clinical profile and outcomes of dematiaceous fungal keratitis - data from a secondary center in rural North India

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  • 发表日期：

    2025年11月26日

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  • Sonali Mehta,
  • Nikunj Vinodbhai Patel,
  • Arpan Gandhi,
  • Isha Chaudhari,
  • Atanu Majumdar,
  • Umang Mathur,
  • Manisha Acharya

摘要

Purpose

To evaluate the clinical course, factors contributing to healing, and outcomes of medically treated dematiaceous fungal keratitis (DFK) at a rural secondary eye care center in North India.

Methods

This retrospective, electronic medical record-based study was conducted over one year at a secondary care center. Patients of all age groups with culture-proven DFK who completed follow-up until corneal healing were included. Demographic, clinical, and microbiological data were analyzed. All patients received therapeutic debridement and natamycin monotherapy. Voriconazole was added in non-responders, and oral antifungals were used for corneal melt or posterior segment involvement. Cases requiring therapeutic keratoplasty (TPK) or evisceration were classified as poor outcomes.

Results

Hundred and eight eyes were included in the study. The mean age was 43.2 years, with 78.7% males. Trauma, most commonly from sugarcane leaves, was reported in 80.6%. Ulcers were mild in 50%, moderate in 39.8%, and severe in 10.2%. Half were small in size; 89.8% were superficial, while 5.6% showed full-thickness involvement. Neurotrophic-like defects were seen in 48.5% and significantly associated with ulcer size (p = 0.004). Healing occurred within 2 weeks in 44.5% and within 4 weeks in 33.7%. Delayed healing (21.8%) correlated with larger, deeper ulcers, hypopyon, and neurotrophic-like defects. TPK/evisceration (12%) was significantly associated with prior steroid use, vascularization, hypopyon, and corneal melt (p < 0.05).

Conclusion

Despite prolonged healing, DFK has a high resolution rate with appropriate medical therapy, minor procedures, and complete debridement. Poor prognostic factors include large and deep infiltrates, hypopyon, and prior steroid use.