Fungal keratitis management in a referral cornea center in Brazil
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista Brasileira de Oftalmologia (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72802020000500315 |
Resumo: | Abstract Purpose: To report etiological diagnosis, predisposing risk factors, therapeutic strategies and visual outcome of patients treated at the Department of Ophthalmology of Federal University of São Paulo. Methods: This is a retrospective, descriptive, and observational study from medical and laboratory records of the Department of Ophthalmology of Federal University of São Paulo, including all patients with culture proven fungal keratitis in 5 years, from October 2012 through October 2017. Results: There were 2260 fungi microbiologic test requests. Of these, 140 samples had positive cultures for fungi and sixty-six patients were followed at our clinic. Forty-five patients (68.2%) were men, and the mean age was 48.06 (±17.39) years. Fusarium spp. was the most frequently isolated fungus (32 cases; 48.5%), followed by Candida parapsilosis (12 cases; 18.2%). Thirty-four patients (51.5%) underwent intracameral injection of amphotericin B (5 µg per 0.1 ml). In 11 patients (32.3%), infection was eradicated after intracameral amphotericin B associated to topical antifungal treatment and, in 23 patients (67.7%), therapeutic keratoplasty was needed. No complication related to intracameral amphotericin B injection was observed in this series. Forty-three patients (65.1%) ended up with therapeutic keratoplasty. Three patients (4.5%) evolved to evisceration or enucleation. At the last follow-up visit, 53 patients (80.3%) had visual acuity worse than 20/200. Conclusion: Despite current antifungals drugs and distinct administration strategies, fungal keratitis remains challenging. Delayed antifungal therapy may explain poor clinical outcomes. Intracameral amphotericin B associated to topical antfungal treatment seems to be a safe and helpful alternative for non-responsive fungal keratitis. But it is important to formulate other treatment strategies, hence to improve patients’ outcomes, since most patients ended-up with significant visual impairment even after current treatment. |
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Fungal keratitis management in a referral cornea center in BrazilAntifungal agentsFungiEye infections, fungalCorneal transplantationKeratitisAbstract Purpose: To report etiological diagnosis, predisposing risk factors, therapeutic strategies and visual outcome of patients treated at the Department of Ophthalmology of Federal University of São Paulo. Methods: This is a retrospective, descriptive, and observational study from medical and laboratory records of the Department of Ophthalmology of Federal University of São Paulo, including all patients with culture proven fungal keratitis in 5 years, from October 2012 through October 2017. Results: There were 2260 fungi microbiologic test requests. Of these, 140 samples had positive cultures for fungi and sixty-six patients were followed at our clinic. Forty-five patients (68.2%) were men, and the mean age was 48.06 (±17.39) years. Fusarium spp. was the most frequently isolated fungus (32 cases; 48.5%), followed by Candida parapsilosis (12 cases; 18.2%). Thirty-four patients (51.5%) underwent intracameral injection of amphotericin B (5 µg per 0.1 ml). In 11 patients (32.3%), infection was eradicated after intracameral amphotericin B associated to topical antifungal treatment and, in 23 patients (67.7%), therapeutic keratoplasty was needed. No complication related to intracameral amphotericin B injection was observed in this series. Forty-three patients (65.1%) ended up with therapeutic keratoplasty. Three patients (4.5%) evolved to evisceration or enucleation. At the last follow-up visit, 53 patients (80.3%) had visual acuity worse than 20/200. Conclusion: Despite current antifungals drugs and distinct administration strategies, fungal keratitis remains challenging. Delayed antifungal therapy may explain poor clinical outcomes. Intracameral amphotericin B associated to topical antfungal treatment seems to be a safe and helpful alternative for non-responsive fungal keratitis. But it is important to formulate other treatment strategies, hence to improve patients’ outcomes, since most patients ended-up with significant visual impairment even after current treatment.Sociedade Brasileira de Oftalmologia2020-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72802020000500315Revista Brasileira de Oftalmologia v.79 n.5 2020reponame:Revista Brasileira de Oftalmologia (Online)instname:Sociedade Brasileira de Oftalmologia (SBO)instacron:SBO10.5935/0034-7280.20200067info:eu-repo/semantics/openAccessBezerra,Fernanda MachadoHöfling-Lima,Ana LuisaOliveira,Lauro Augusto deeng2020-11-17T00:00:00Zoai:scielo:S0034-72802020000500315Revistahttps://rbo.emnuvens.com.br/rbo/indexhttps://old.scielo.br/oai/scielo-oai.phpsob@sboportal.org.br||rbo@sboportal.org.br1982-85510034-7280opendoar:2020-11-17T00:00Revista Brasileira de Oftalmologia (Online) - Sociedade Brasileira de Oftalmologia (SBO)false |
dc.title.none.fl_str_mv |
Fungal keratitis management in a referral cornea center in Brazil |
title |
Fungal keratitis management in a referral cornea center in Brazil |
spellingShingle |
Fungal keratitis management in a referral cornea center in Brazil Bezerra,Fernanda Machado Antifungal agents Fungi Eye infections, fungal Corneal transplantation Keratitis |
title_short |
Fungal keratitis management in a referral cornea center in Brazil |
title_full |
Fungal keratitis management in a referral cornea center in Brazil |
title_fullStr |
Fungal keratitis management in a referral cornea center in Brazil |
title_full_unstemmed |
Fungal keratitis management in a referral cornea center in Brazil |
title_sort |
Fungal keratitis management in a referral cornea center in Brazil |
author |
Bezerra,Fernanda Machado |
author_facet |
Bezerra,Fernanda Machado Höfling-Lima,Ana Luisa Oliveira,Lauro Augusto de |
author_role |
author |
author2 |
Höfling-Lima,Ana Luisa Oliveira,Lauro Augusto de |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Bezerra,Fernanda Machado Höfling-Lima,Ana Luisa Oliveira,Lauro Augusto de |
dc.subject.por.fl_str_mv |
Antifungal agents Fungi Eye infections, fungal Corneal transplantation Keratitis |
topic |
Antifungal agents Fungi Eye infections, fungal Corneal transplantation Keratitis |
description |
Abstract Purpose: To report etiological diagnosis, predisposing risk factors, therapeutic strategies and visual outcome of patients treated at the Department of Ophthalmology of Federal University of São Paulo. Methods: This is a retrospective, descriptive, and observational study from medical and laboratory records of the Department of Ophthalmology of Federal University of São Paulo, including all patients with culture proven fungal keratitis in 5 years, from October 2012 through October 2017. Results: There were 2260 fungi microbiologic test requests. Of these, 140 samples had positive cultures for fungi and sixty-six patients were followed at our clinic. Forty-five patients (68.2%) were men, and the mean age was 48.06 (±17.39) years. Fusarium spp. was the most frequently isolated fungus (32 cases; 48.5%), followed by Candida parapsilosis (12 cases; 18.2%). Thirty-four patients (51.5%) underwent intracameral injection of amphotericin B (5 µg per 0.1 ml). In 11 patients (32.3%), infection was eradicated after intracameral amphotericin B associated to topical antifungal treatment and, in 23 patients (67.7%), therapeutic keratoplasty was needed. No complication related to intracameral amphotericin B injection was observed in this series. Forty-three patients (65.1%) ended up with therapeutic keratoplasty. Three patients (4.5%) evolved to evisceration or enucleation. At the last follow-up visit, 53 patients (80.3%) had visual acuity worse than 20/200. Conclusion: Despite current antifungals drugs and distinct administration strategies, fungal keratitis remains challenging. Delayed antifungal therapy may explain poor clinical outcomes. Intracameral amphotericin B associated to topical antfungal treatment seems to be a safe and helpful alternative for non-responsive fungal keratitis. But it is important to formulate other treatment strategies, hence to improve patients’ outcomes, since most patients ended-up with significant visual impairment even after current treatment. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-10-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72802020000500315 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72802020000500315 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.5935/0034-7280.20200067 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Oftalmologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Oftalmologia |
dc.source.none.fl_str_mv |
Revista Brasileira de Oftalmologia v.79 n.5 2020 reponame:Revista Brasileira de Oftalmologia (Online) instname:Sociedade Brasileira de Oftalmologia (SBO) instacron:SBO |
instname_str |
Sociedade Brasileira de Oftalmologia (SBO) |
instacron_str |
SBO |
institution |
SBO |
reponame_str |
Revista Brasileira de Oftalmologia (Online) |
collection |
Revista Brasileira de Oftalmologia (Online) |
repository.name.fl_str_mv |
Revista Brasileira de Oftalmologia (Online) - Sociedade Brasileira de Oftalmologia (SBO) |
repository.mail.fl_str_mv |
sob@sboportal.org.br||rbo@sboportal.org.br |
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1752122339115401216 |