Trends in Fungal Keratitis in the United States, 2001 to 2007

doi:10.1016/j.ophtha.2010.03.048

Ophthalmology

Volume 117, Issue 12, December 2010, Pages 2263-2267

https://doi.org/10.1016/j.ophtha.2010.03.048 Get rights and content

Objective

Fungal keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium keratitis outbreak raised questions regarding the background rate of Fusarium-related keratitis and other fungal keratitis in this population.

Design

Retrospective, multicenter case series.

Participants

Six hundred ninety-five cases of fungal keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007.

Methods

Ten tertiary care centers in the United States performed a retrospective review of culture-positive fungal keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research.

Main Outcome Measures

Quarterly number of fungal keratitis cases and fungal species.

Results

We identified 695 fungal keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 (P<0.0001).

Conclusions

The quarterly number of Fusarium fungal keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous fungal keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Methods

Eleven academic ophthalmic centers across the United States were invited to participate in a review of fungal keratitis cases at their centers (Table 1). One center (University of Texas, Southwestern) was unable to provide data for a substantial portion of the study timeframe owing to a change in computer systems. Because this analysis investigates time trends, data from that center could not be used. Thus, data reported in this manuscript are from 10 centers with complete reporting. Centers

Results

Across the 10 centers with full reporting, 695 cases of fungal keratitis were identified over the 7-year study period. Among these cases, 664 were confirmed through positive corneal cultures, including corneal scrapes, corneal biopsies and corneal buttons (Table 1). An additional 26 cases were confirmed through histology, and 5 were confirmed via confocal microscopy. Men accounted for 53% of the population, and the median age was 48 years.

Forty-one percent (n = 283) of all cases were CLWs. The

Discussion

We have reported herein a large case series of fungal keratitis cases reported from tertiary eye care centers across the United States over a 7-year period. In general, the quarterly number of fungal keratitis cases was higher among non-CLWs than among refractive CLWs. This finding is consistent with prior reports of the primary causes of fungal keratitis in the United Staets.19, 21 Although it is difficult to quantify what proportion of fungal keratitis cases are seen at tertiary/university

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: Manuscript no. 2009-1576.

: Financial Disclosure(s): The authors have made the following disclosures: Eduardo Alfonso – Consultant – Bausch & Lomb, Inc. Oliver Schein – Consultant – Bausch & Lomb Inc. R. Doyle Stulting – Consultant – Allergan Incorporated and Alcon Laboratories Inc. Emily Gower – Grant support – Bausch & Lomb Inc. This project was funded by an unrestricted grant from Bausch & Lomb, Incorporated. Bausch & Lomb did not provide input into the content of this manuscript. Funded through an unrestricted grant from Bausch & Lomb Incorporated. B&L did not have input on the content of the manuscript or the analyses. Dr. Gower is a recipient of the Research to Prevent Blindness Althouse Special Scholars Award.

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Original articleTrends in Fungal Keratitis in the United States, 2001 to 2007

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Risk factors and causative organisms in microbial keratitis

Cornea

Age-related risk factors, culture outcomes, and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers

Cornea

Fungal keratitis at the New York Eye and Ear Infirmary

Cornea

Predisposing factors and etiologic diagnosis of ulcerative keratitis

Cornea

Comparison of topical 0.3% ofloxacin with fortified tobramycin plus cefazolin in the treatment of bacterial keratitis

Eye (Lond)

Microbial keratitis in South India: influence of risk factors, climate, and geographical variation

Ophthalmic Epidemiol

Clinical and microbial spectrum of fungal keratitis in Singapore: a 5-year retrospective study

Int Ophthalmol

Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis

Br J Ophthalmol

Original article
Trends in Fungal Keratitis in the United States, 2001 to 2007