Department of Ophthalmology & Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; and.
Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Cornea. 2020 Jul;39(7):801-805. doi: 10.1097/ICO.0000000000002306.
To examine the epidemiological characteristics, trends, risk factors, management strategies, and clinical outcomes of Candida albicans and non-albicans keratitis over a 15-year period in a tertiary Canadian eye center.
In a retrospective observational case series of Candida keratitis from 2003 to 2017, demographics, risk factors, corrected distance visual acuity (CDVA) at initial and final consultations, medical and surgical management, and follow-up duration were recorded.
Twenty-one cases of Candida keratitis were identified (62.5% of total fungal keratitis; 10 C. albicans and 11 non-albicans). The most commonly associated risk factors were topical steroid use (16 patients, 76%), ocular surface disease (15 patients, 71%), contact lens use (11 patients, 52%), and previous corneal surgery (8 patients, 38%); all patients had 2 or more combined risk factors. The number of patients with a visual acuity of 20/200 or better remained the same before and after the treatment (5/21, 24%). The mean duration of the antifungal treatment was 98 ± 126 days. Sixteen patients ultimately required surgical management (76%; 12 therapeutic keratoplasties, 3 enucleation, and 1 optical keratoplasty). When comparing C. albicans with non-albicans keratitis, we found no difference in presenting visual acuity, final visual acuity, or requirement for surgical management.
Candida keratitis accounts for the most identified fungal keratitis cases in this temperate climate area. An exposure to multiple risk factors appears necessary. A surgical intervention is required for the resolution of most cases. Different subspecies of Candida ultimately resulted in similar clinical outcomes.
在加拿大一家三级眼科中心，研究 15 年来白色念珠菌和非白色念珠菌角膜炎的流行病学特征、趋势、危险因素、治疗策略和临床结局。
对 2003 年至 2017 年的念珠菌角膜炎进行回顾性观察性病例系列研究，记录患者的人口统计学特征、危险因素、初始和最终就诊时的矫正视力（CDVA）、药物和手术治疗以及随访时间。
共发现 21 例念珠菌角膜炎（占真菌性角膜炎的 62.5%；10 例白色念珠菌和 11 例非白色念珠菌）。最常见的相关危险因素是局部使用皮质类固醇（16 例，76%）、眼表疾病（15 例，71%）、角膜接触镜使用（11 例，52%）和既往角膜手术（8 例，38%）；所有患者均有 2 种或多种联合危险因素。治疗前后视力为 20/200 或更好的患者数量保持不变（21 例中有 5 例，24%）。抗真菌治疗的平均持续时间为 98 ± 126 天。16 例患者最终需要手术治疗（76%；12 例治疗性角膜移植术，3 例眼球摘除术，1 例光学性角膜移植术）。比较白色念珠菌和非白色念珠菌角膜炎，我们发现两者的初始视力、最终视力或手术治疗的需求均无差异。
在这个温带气候地区，白色念珠菌角膜炎占所鉴定的真菌性角膜炎病例的大多数。似乎需要接触多种危险因素。大多数病例需要手术干预才能解决。不同的念珠菌亚种最终导致了相似的临床结局。
