1. ID: 287 Fusarium keratitis in a tertiary eye care centre in India Sujata Das, MS, FRCS Savitri Sharma, MD Samir Mahapatra, MS Srikant K Sahu, MS L V Prasad Eye Institute Bhubaneswar, India, 751024 sujatadas@lvpei.org Authors do not have any financial or conflicting interests to disclose

2. ID: 287 Introduction # Srinivasan M, et al. Br J Ophthalmol 1997; 81: 965-971. # Gopinathan U, et al. Cornea 2002; 21: 555-559. # Dunlop AA, et al. Aust N Z J Ophthalmol 1994; 22: 105-110. # Hagan M, et al. Br J Ophthalmol 1995; 79: 1024-1028. @ O’Brien TP, Rhee P. In Textbook of Ocular Pharmacology. Hagerstown: Lipincott-Raven, 1997: 587-607. @ O’Day D. In Ocular Infection and Immunity. St Louis: Mosbey, 1996: 1048-1061.  Fungal keratitis continues to be a cause of concern to ophthalmologists.  It accounts for 30 to 50% of all cases of microbial keratitis in developing countries. #  Increased awareness coupled with improved laboratory and in vivo diagnostic techniques have led to an increase in the frequency of correct diagnosis and consequent increase in prevalence of the disease. @

3. ID: 287  The epidemiological features of fungal keratitis vary across geographic regions and climatic conditions.  Fungal keratitis occurs more frequently in warm, and dry climate than in temperate zones.  Fusarium and Aspergillus species are the most common fungi isolated from patients in tropical regions.  The purpose of the study was to report clinical and microbiological profile of Fusarium keratitis. Introduction

4. ID: 287 Material and Methods  A retrospective analysis of medical records was done to study the clinical and microbiological profile of 42 consecutive culture-proven Fusarium keratitis patients presented at the corneal unit of L V Prasad Eye Institute, Bhubaneswar, between November 2006 & July 2009.  The following data were collected from each record: age, sex, predisposing risk factor, clinical presentation, microbiological result, mode of management, and final outcome.  All patients had undergone detailed clinical evaluation and slit-lamp examination.

5. ID: 287 Material and Methods Smearing on glass slides Gram Giemsa Placing on glass slide KOH/CFW CA (CO 2 ) BA (O 2 +) BA (O 2 - ) BHI Thio SDA NNA ( E. coli ) PDA obtained As a part of standard protocol, corneal scrapings were obtained from all microbial keratitis and subjected to the following :

6. ID: 287 Clinical Picture

7. ID: 287 Results  Mean age of patients was 47±17 (range: 4-95, median: 45) years.  Eleven eyes (26.2%) had history of injury.  Mean duration of symptom was 17±14 (range: 3-60, median: 10) days. 42.86% 57.14%  Hypopyon was present in 15 (35.7%) cases.  Satellite lesion was not present in any eye.

8. ID: 287  Thirty six (85.7%) cases were smear-positive for fungus.  In 3 cases microconidia was observed in direct smear examination.  Fusarium solani was the most common (45.2%) fungi.  Five patients had associated bacterial infection. Results  All 3 cases where microconidia was present in direct smear examination were identified as Fusarium solani in culture.  The mean time to positive culture was 1.8±1 days.

9. ID: 287 BA CA SDA SDA Giemsa 1000 Microbiological Examination

10. ID: 287 Gram 1000 LCPB 400 CFW 200 Adventitious Sporulation

11. ID: 287  Twenty one (50%) patients underwent adjunctive surgical procedure Tissue adhesive application : n = 9; Tissue adhesive application : n = 9; Therapeutic penetrating keratoplasty : n = 13; Therapeutic penetrating keratoplasty : n = 13; Anterior chamber wash + Intracameral antifungal : n = 4; Anterior chamber wash + Intracameral antifungal : n = 4; Evisceration : n = 3. Evisceration : n = 3.  16.7% and 41.5% patients had visual acuity of <20/200 during presentation and final follow-up respectively.  Eighteen patients had improvement in visual acuity. Results

12. ID: 287  Fusarium keratitis may present after trauma without any satellite lesion and needs surgical intervention in 50% cases.  Smears of corneal scrapings often disclosed hyphae, and culture media showed growth within 3 days.  Microconidia in smear examination may be suggestive of Fusarium solani. Conclusion