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Diagnosis and medical treatment of fungal keratitis

A significant trend is a move away from yeast infections and toward filamentous fungal keratitis over the past decade

Posted: Thursday, February 16, 2017

Matthew Burton

Matthew Burton PhD, London, UK, gave the keynote speech on infectious keratitis at the annual Cornea Day, during the 21st ESCRS Winter Meeting in Maastricht, The Netherlands.

“A significant trend is a move away from yeast infections and toward filamentous fungal keratitis over the past decade, which currently cause 70% of fungal infections in our hospital,” said Dr Burton. A reverse trend has been noted in candida infections.

Regarding the diagnostic approach, Dr Burton advised delegates to focus on potential risk factors, including contact lens use, ocular surface disease, trauma, surgery and especially tropical travel.

“Travel history is often overlooked, despite it’s great importance,” said Dr Burton. The closer the patient has travelled to the equator, the higher the proportion of fungal keratitis.

Diagnostics should include in vivo confocal microscopy (IVCM), scrape for microbiology, PCR and biopsy.

“IVCM can be a very valuable modality, particularly for deeper infections not amenable to the other diagnostic approaches,” he said.

IVCM can be a very valuable modality, particularly for deeper infections not amenable to the other diagnostic approaches

Dr Burton also reviewed the evidence that guided his approach to treatment. The most valuable studies compared topical treatments such as natamycin, voriconazole and chlorhexidine, as well as oral and intrastromal voriconazole. Dr Burton reminded delegates to be particularly careful with oral voriconazole, which can lead to fatal hepatotoxicity.

“Despite the potential for success of medical treatments, don’t be afraid to consider surgery with there’s no treatment response or when the limbus becomes involved,” he concluded.

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