Retrospective Review of Fungal Keratitis at Two Tertiary Hospitals in Perth, Western Australia Between 2006 and 2022

Abstract

Background: Fungal keratitis is a significant cause of ocular morbidity globally. There is a lack of contemporary local data in Western Australia.

Methods: A retrospective chart review of fungal keratitis cases at two tertiary hospitals in Perth, Western Australia identified between 1 January 2006 and 31 December 2022. Data on patient demographics, isolated organisms, risk factors, clinical features, outcomes, and management were collected and analysed.

Results: There were 68 cases of clinically significant fungal keratitis with positive culture results from corneal scrapes. The most commonly isolated pathogens were Fusarium species (37%), Candida species (28%), Scedosporium species (10%), and Aspergillus species (9%). The most common predisposing risk factors were prior use of topical corticosteroids (40%), contact lens wear (35%), ocular surface disease (without a corneal graft) (25%), ocular trauma (including organic matter exposure) (18%), and a previous corneal graft procedure (16%). Corneal perforation occurred in 25% of cases. A high proportion, 22 episodes in 18 eyes (26%), of patients required therapeutic penetrating keratoplasty, and 6% required evisceration.

Conclusions: Results were largely consistent with previous studies in the Australian context. Fusarium species and Candida albicans were the most common pathogens isolated. Prior topical corticosteroid use was the most common predisposing risk factor, followed closely by contact lens wear and ocular surface disease. A large proportion of patients experienced corneal perforations and required penetrating keratoplasty.

Keywords: corneal perforation; fungal keratitis; natamycin; therapeutic keratoplasty; voriconazole.