Management of Mycotic Keratitis ID : 325 Chief author: Sudesh Kumar Arya Co-authors: Anamika Garg Jagdish Chander Archana Malik Sunandan Sood Department of Ophthalmology and Microbiology Government Medical College & Hospital Chandigarh,India The Authors have no financial interest

Introduction Aim of the Study Infective keratitis is a suppurative infection of cornea which may be associated with epithelial defects and / or signs of inflammation. Fungi - responsible for nearly 1/3rd of infective keratitis Mycotic keratitis remains a diagnostic and therapeutic challenge to the ophthalmologist. Difficulties are related to establishing a clinical diagnosis, isolating the etiologic fungal organism in the laboratory, and treating the keratitis effectively with topical antifungal agents or by surgery. Aim of the Study To find out demographic profile, type of intervention and final outcome of mycotic keratitis in a tertiary care centre. Introduction

Materials and Methods Retrospective analysis of case records of 82 eyes of 82 patients from 2004 – 2009 having mycotic keratitis was done. Exclusion criteria: Proven case of bacterial or viral keratitis Mixed corneal ulcer

Materials and Methods cont… Demographic profile of patient Relevant history (Predisposing factor) Grading of ulcer ( size of ulcer, size of corneal infiltrates, scleral involvement, size of perforation if any) Microbiological data ( Gram stain, KOH stain, Culture sensitivity for bacteria and fungus ) Type of intervention done ( Medical treatment with antifungals or mixed treatment, Glue with BCL, TPK, any other like AMT, Cyclocryotherapy, Intracameral or intrastromal Amphotericin B ) Duration of Medical treatment and number of surgical interventions

Observation and Results 82 patients included Age 17-90 years (Mean age 46.37 yrs) 61 males, 21 females (M:F – 2.9 : 1) 75.6% from rural background

Various Types of Mycotic Keratitis Fungal plaque with hypopyon Feathery margins Infilterates with pigmentation Corneal abscess

Predisposing factors

Type of Interventions

Clear Grafts in Mycotic Keratitis

Results cont… KOH positivity was present in 25 patients (incidence 20%). Culture positivity for fungus was present in 18 patients ( incidence 14.76%). 45% of the cases of mycotic keratitis eventually needed TPK. 9.7% of the patients needed other interventions like intracameral Amphotericin B (4.8% cases), AMT (3.7% cases) and Intrastromal Amphotericin B (1.2% cases) in addition to medical treatment or TPK.

Discussion 25%-35% of cases of fungal keratitis require performance of a TPK to maintain ocular integrity. (Cornea 2002) While our study showed that upto 45% of the cases eventually need TPK. Stage at which PKP was done : Indian Western GMCH Grade 3 (5-7mm) 6% 75% 71% Grade 4 (7-10mm) 75% 20% 21% Grade 5 (Tot.invl.) 10% - 8%

Conclusions Mycotic keratitis is a preventable cause of corneal blindness. Prompt clinical diagnosis aided with Microbiological support is vital for success of Medical Therapy Surgical intervention is one of the most important modalities for salvaging the eye in mycotic keratitis. Early surgical intervention is advocated if patient is not responding to treatment. Predisposed persons should be educated for proper safety measures