Clinical features, microbiological characteristics, and treatment outcomes of fungal keratitis in a tertiary referral hospital in Eastern China

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BACKGROUND: Fungal keratitis (FK) is a serious corneal disease that was considered as the main cause of vision loss in developing countries. Early diagnosis and timely treatment of FK can significantly strengthen the curative effect and decrease the risk of the blindness. The fungal spectrum varies and is closely associated with climate and geographic location. The clinical characteristics of FK in eastern China are limited. We explored the risk factors, fungal species, characteristics of in vivo confocal microscopy (IVCM), and treatment of FK in a tertiary referral hospital in eastern China. METHODS: This retrospective study encompassed a thorough analysis of clinical data, IVCM images, and fungal cultures in FK between January 2021 and May 2024. The clinical profiles, microbial characteristics, and therapeutic outcomes of these patients were meticulously analyzed. RESULTS: A total of 174 patients were diagnosed with FK. Seven fungal species were identified in 104 culture-positive cases. Fusarium was the most common species (49.04%), followed by Alternaria (23.08%) and Aspergillus (15.38%). 166 (95.4%) patients showed evidence of mycelia or spores in IVCM images. Diverse fungal strains typically showed varied culture characteristics and IVCM expressions. 42 (24.14%) patients were successfully treated with topical medicine alone, and 132 (75.86%) patients needed additional surgical therapies, including intrastromal injections of voriconazole (38.51%), conjunctival pedicle flap surgery (8.05%), lamellar keratoplasty (22.41%), penetrating keratoplasty (4.02%), and enucleation (2.87%). Visual acuity improved in 104 patients (59.77%), but remained unchanged in 36 (20.69%) patients and decreased in 34 patients (19.54%) following active treatment. CONCLUSIONS FUSARIUM: was the most frequently isolated species, followed by Alternaria and Aspergillus.

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