Fusarium keratitis at a tertiary eye care centre in India

Abstract

The aim of the study was to report the clinical and microbiological profiles of Fusarium keratitis. In this single-centre, retrospective, non-comparative case series, 47 laboratory-confirmed cases of keratitis caused by Fusarium species treated at the L V Prasad Eye Institute, Bhubaneswar, India, between November 2006 and October 2009, were reviewed. The analysis included predisposing factors, clinical characteristics, microbiological findings, treatment and outcome. Forty-seven samples of 47 patients were included in the study. The mean age of the 47 patients was 46 ± 17 years. Twelve eyes had a history of injury. Corneal scraping could not be done in one of the cases due to large perforation. Fungal filaments were detected in corneal scraping in 41 cases, and in three cases microconidia were observed in microscopy. Fusarium solani was the most common species (44.7 %). All three cases where microconidia were present in smear were identified as F. solani in culture. The mean time to positive culture was 2.4 ± 1.5 days. Twenty-three patients underwent adjunctive surgical procedure. Visual acuity of <20/200 at presentation and final follow-up was noted in 80.9 and 51.4 % patients, respectively. One-half (23/47) of the patients had improvement in visual acuity. Fusarium keratitis may present after trauma without any satellite lesion, and the response to medical therapy is generally poor. Rapid diagnosis can be made by smear examination of corneal scrapings in a majority of the cases and confirmed by culture within 2-3 days. Presence of microconidia in smear examination may be suggestive of F. solani.