Ting Darren Shu Jeng, Galal Mohamed, Kulkarni Bina, Elalfy Mohamed S, Lake Damian, Hamada Samer, Said Dalia G, Dua Harminder S
Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK.
Queen's Medical Centre, Nottingham NG7 2RD, UK.
J Fungi (Basel). 2021 Nov 12;7(11):966. doi: 10.3390/jof7110966.
Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen's Medical Centre, Nottingham, and the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients ( = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4-92 years) and 51.3% of patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with spp. (33, 62.3%), spp. (9, 17.0%), and spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9 ± 16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67 ± 1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3 mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all < 0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.
真菌性角膜炎（FK）是一种严重的眼部感染，常常带来重大的诊断和治疗难题。本研究旨在调查英国真菌性角膜炎的病因、临床特征、治疗结果及预后因素。纳入了2011年至2020年间就诊于诺丁汉女王医疗中心和东格林斯特德维多利亚女王医院的所有培养阳性和培养阴性的疑似真菌性角膜炎病例（数据完整）。本研究纳入了117例真菌性角膜炎患者（117只眼）。平均年龄为59.0±19.6岁（范围4 - 92岁），51.3%的患者为女性。从52例（44.4%）培养阳性病例中鉴定出53株真菌分离株，其中曲霉菌属（33株，62.3%）、镰刀菌属（9株，17.0%）和念珠菌属（5株，9.4%）是最常见的病原体。眼表疾病（60例，51.3%）、既往角膜手术史（44例，37.6%）和全身免疫抑制（42例，35.9%）是三个最常见的危险因素。95例（81.2%）患者需要住院接受强化治疗，住院时间为18.9±16.3天。66例（56.4%）患者需要额外的手术干预以根除感染。29例（24.8%）患者接受了急诊治疗性/结构性角膜移植术，不过其中13例（44.8%）在最终随访时治疗失败。最终矫正远视力（CDVA）为1.67±1.08 logMAR。多变量逻辑回归分析显示，年龄增加、浸润灶较大（>3 mm）以及初始矫正远视力较差（<1.0 logMAR）是视力预后不良（CDVA<1.0 logMAR）和角膜愈合不佳（愈合时间>60天或发生角膜穿孔需要急诊角膜移植术；所有P<0.05）的显著负性预测因素。总之，真菌性角膜炎是一种难以治疗的眼部感染，常常导致视力预后不良，对手术干预的需求很高。迫切需要创新的治疗策略来满足这一未被满足的需求。
