Purpose: To review the distribution, current trends, and response  patterns for treatment of fungal keratitis isolates in costal districts over the last 2 years

Methods

Design: Retrospective, observational, case series.

Participants: Microbiology records of suspected  fungal  keratitis cases that underwent a diagnostic corneal scraping and cultures from March 1,2010,  through April 31, 2012,at sankar foundation eye hospital, teritiary eye care and referral center, were reviewed. Culture results and medical and surgical management response were reviewed and analyzed.

Results:  A total of 450corneal scrapings were taken during the 2years of the study.  Pathogen was recovered in 380 samples (84.4%), with fungal keratitis accounting for 350 of the positive cultures (81.5%). Asperigillus 48.15%, Fusarium 43.15%, Yeast 0.2%, Paecillomysis0.52%, and Acremonium 0.52%, not able to grow in 7.63%. Out of 380 cases 315 cases responded for topical antifungals, 75 cases with deep infiltrates and endoexudates resistant to topical medication alone, 33cases posted for  TPK , 42cases treated with intracameral Ampho-B 10-15 u and intrastromal  7.5microns at least 2-3 times along with oral anti fungals.

Conclusions:  1. About 90%  h/o of injury with vegetable matter,2.Pts who presented early are responded very well with Natamycin 5%e/d and Fluconazole e/d along with repeated superficial debridement . If not responding addition of Amphotericin B 0.2%e/d hrly is with good results, 3.Deep infiltrates and endoexudate cases those who were given intracameral and intra stromal along with oral azoles doing well than TPK patients after optical PKP. 6. Topical Voriconazole 20% e/d (aurolab) did not give any added advantage except in few cases. 7.Pts on  steroids were refractory to maximum medical treatment ultimately going for surgical intervention.

Keywords: fungal keratitis, asperigillous, natamycin, vozole, intracameral Ampho-B, deep keratitis, TPK.