management of mycotic keratitis
DESCRIPTION
ID : 325. Management of Mycotic Keratitis. Chief author: Sudesh Kumar Arya Co-authors : Anamika Garg Jagdish Chander Archana Malik Sunandan Sood. Department of Ophthalmology and Microbiology - PowerPoint PPT PresentationTRANSCRIPT
Management of Mycotic Management of Mycotic KeratitisKeratitis
Chief author: Sudesh Kumar Chief author: Sudesh Kumar AryaArya
Co-authorsCo-authors: Anamika Garg: Anamika Garg Jagdish Chander Jagdish Chander
Archana Malik Archana Malik Sunandan SoodSunandan Sood
The Authors have no financial interest
ID : 325
Department of Ophthalmology and Microbiology Government Medical College & Hospital
Chandigarh,India
Infective keratitis is a suppurative infection of cornea which may be
associated with epithelial defects and / or signs of inflammation.
FungiFungi - responsible for nearly - responsible for nearly 1/31/3rdrd of infective keratitis of infective keratitis
Mycotic keratitis remains a diagnostic and therapeutic challenge to Mycotic keratitis remains a diagnostic and therapeutic challenge to thethe
ophthalmologist. Difficulties are related to establishing a clinical ophthalmologist. Difficulties are related to establishing a clinical diagnosis, isolating the etiologic fungal organism in the laboratory, diagnosis, isolating the etiologic fungal organism in the laboratory, and treating the keratitis effectively with topical antifungal agents and treating the keratitis effectively with topical antifungal agents or by surgery.or by surgery.
Aim of the StudyAim of the Study To find out demographic profile, type of intervention and final To find out demographic profile, type of intervention and final
outcome of mycotic keratitis in a tertiary care centre.outcome of mycotic keratitis in a tertiary care centre.
Introduction
Materials and Materials and MethodsMethods
Retrospective analysis of case records of Retrospective analysis of case records of
82 eyes of 82 patients from 2004 – 2009 82 eyes of 82 patients from 2004 – 2009
having mycotic keratitis was done.having mycotic keratitis was done.
Exclusion criteria:Exclusion criteria: Proven case of bacterial or viral keratitisProven case of bacterial or viral keratitis Mixed corneal ulcerMixed corneal ulcer
Demographic profileDemographic profile of patient of patient
Relevant history (Relevant history (Predisposing factorPredisposing factor))
Grading of ulcerGrading of ulcer ( size of ulcer, size of corneal infiltrates, ( size of ulcer, size of corneal infiltrates,
scleral involvement, size of perforation if any)scleral involvement, size of perforation if any)
Microbiological dataMicrobiological data ( Gram stain, KOH stain, Culture ( Gram stain, KOH stain, Culture
sensitivity for bacteria and fungus )sensitivity for bacteria and fungus )
Type of Type of interventionintervention done ( Medical treatment with done ( Medical treatment with
antifungals or mixed treatment, Glue with BCL, TPK, any other antifungals or mixed treatment, Glue with BCL, TPK, any other
like AMT, Cyclocryotherapy, Intracameral or intrastromal like AMT, Cyclocryotherapy, Intracameral or intrastromal
Amphotericin B )Amphotericin B )
Duration of Medical treatment and number of surgical Duration of Medical treatment and number of surgical
interventionsinterventions
Materials and Methods cont…Materials and Methods cont…
Observation and Observation and ResultsResults
82 patients included82 patients included
Age 17-90 years Age 17-90 years (Mean age (Mean age
46.37 yrs)46.37 yrs)
61 males, 21 females 61 males, 21 females (M:F – (M:F –
2.9 : 1)2.9 : 1)
75.6%75.6% from rural background from rural backgroundmales
females
males
females
Feathery margins Fungal plaque with hypopyon
Infilterates with pigmentation Corneal abscess
Various Types of Mycotic Keratitis
Predisposing factorsPredisposing factors
21
3
27
31
0
5
10
15
20
25
30
35
vegetativematter
cowtail injury unknown others
50%
12.20%14.60%
30.50%
9.70%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Onlyantifungals
Mixed Rx Medical Rxwith TPK
Early TPK Otherinterventions
Type of InterventionsType of Interventions
Results cont…Results cont… KOH positivity was present in 25 patients KOH positivity was present in 25 patients (incidence (incidence
20%).20%).
Culture positivity for fungus was present in 18 patientsCulture positivity for fungus was present in 18 patients
( incidence 14.76%).( incidence 14.76%).
45%45% of the cases of mycotic keratitis eventually of the cases of mycotic keratitis eventually needed needed
TPK.TPK.
9.7% of the patients needed other interventions like 9.7% of the patients needed other interventions like
intracameral Amphotericin B (4.8% cases), AMT (3.7% intracameral Amphotericin B (4.8% cases), AMT (3.7%
cases)cases) and Intrastromal Amphotericin B (1.2% cases) in and Intrastromal Amphotericin B (1.2% cases) in
addition to medical treatment or TPK.addition to medical treatment or TPK.
DiscussionDiscussion 25%-35%25%-35% of cases of fungal keratitis require of cases of fungal keratitis require
performance of a TPK to maintain ocular integrity. performance of a TPK to maintain ocular integrity. (Cornea 2002)(Cornea 2002)
While our study showed that upto While our study showed that upto 45%45% of the cases of the cases
eventually need TPK. eventually need TPK.
Stage at which PKP was doneStage at which PKP was done : :
IndianIndian WesternWestern GMCHGMCH Grade 3 (5-7mm) 6% 75% 71%Grade 3 (5-7mm) 6% 75% 71% Grade 4 (7-10mm) 75% 20% 21%Grade 4 (7-10mm) 75% 20% 21% Grade 5 (Tot.invl.) 10% - 8% Grade 5 (Tot.invl.) 10% - 8%
ConclusionsConclusions Mycotic keratitis is a preventable cause of corneal Mycotic keratitis is a preventable cause of corneal
blindness.blindness.
Prompt clinical diagnosisPrompt clinical diagnosis aided with aided with Microbiological Microbiological
supportsupport is vital for success of Medical Therapy is vital for success of Medical Therapy
Surgical intervention is one of the most important Surgical intervention is one of the most important
modalities for salvaging the eye in mycotic keratitis. modalities for salvaging the eye in mycotic keratitis. Early surgical intervention is advocated if patient is Early surgical intervention is advocated if patient is
not responding to treatment.not responding to treatment. Predisposed persons should be Predisposed persons should be educated for proper educated for proper
safety measuressafety measures