Jastaneiah Sabah S, Al-Rajhi Ali A, Abbott David
Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia.
Saudi J Ophthalmol. 2011 Jul;25(3):231-8. doi: 10.1016/j.sjopt.2011.04.004. Epub 2011 Apr 30.
To review the clinical experience of fungal keratitis cases at King Khaled Eye Specialist Hospital (KKESH) in Riyadh, Saudi Arabia.
Retrospective observational review and analysis of 124 patient charts with confirmed diagnosis of fungal keratitis between 1984 and 2004.
One hundred and twenty four eyes of 124 patients had proven fungal infection; 101 eyes had fungal keratitis and 23 eyes had fungal endophthalmitis complicating keratitis. Estimated proportion of fungal keratitis and endophthalmitis was 10.3%. Mean age was 55 years with male predominance (79.0%). Commonly associated factors were previous intraocular surgery (38.7%) and trauma (20.9%). Major risk factor for progressing to endophthalmitis was previous intraocular surgery (65.2%), p < 0.001. Initial laboratory results were fungal positive only in 30.6% (p < 0.001). Commonest organisms isolated were Aspergillus spp. (29.8%) followed by Trichophyton sp. (16.1%), then Candida and Fusarium sp. Comparison of both phases of the study showed improvement in the rate of successfully treated cases from 34.6% to 58.3%, and a decline in cases progressing to endophthalmitis from 25.0% to 13.9%. Therapeutic penetrating keratoplasty increased from 26.9% to 73.6% (p < 0.001). Thirteen eyes required enucleation or evisceration.
In contrast to other studies on fungal keratitis, Aspergillusspp. and Trichophyton sp. were the most commonly isolated fungal pathogens; the former carries the worst prognosis. Risk factors included previous intraocular surgery and trauma. Poor outcome was associated with Aspergillus spp., delayed presentation, previous intraocular surgery and late surgical intervention. This study recommends early surgical intervention to improve the outcome.
回顾沙特阿拉伯利雅得市国王哈立德眼科专科医院（KKESH）真菌性角膜炎病例的临床经验。
对1984年至2004年间确诊为真菌性角膜炎的124例患者病历进行回顾性观察分析。
124例患者的124只眼证实有真菌感染；101只眼患有真菌性角膜炎，23只眼患有真菌性眼内炎并发角膜炎。真菌性角膜炎和眼内炎的估计比例为10.3%。平均年龄为55岁，男性占主导（79.0%）。常见相关因素为既往眼内手术（38.7%）和外伤（20.9%）。进展为眼内炎的主要危险因素是既往眼内手术（65.2%），p<0.001。初始实验室结果仅30.6%为真菌阳性（p<0.001）。分离出的最常见病原体是曲霉菌属（29.8%），其次是毛癣菌属（16.1%），然后是念珠菌属和镰刀菌属。研究两个阶段的比较显示，成功治疗病例的比例从34.6%提高到58.3%，进展为眼内炎的病例从25.0%下降到13.9%。治疗性穿透性角膜移植术从26.9%增加到73.6%（p<0.001）。13只眼需要眼球摘除或眼内容剜除术。
与其他关于真菌性角膜炎的研究相比，曲霉菌属和毛癣菌属是最常见分离出的真菌病原体；前者预后最差。危险因素包括既往眼内手术和外伤。不良预后与曲霉菌属、就诊延迟、既往眼内手术和手术干预延迟有关。本研究建议早期手术干预以改善预后。
