FUNGAL CORNEAL ULCERS: A PROSPECTIVE STUDY ON THE CAUSATIVE FUNGUS AND THE RESPONSE TO THE PRESENT TREATMENT PROTOCOL

BACKGROUND Fungal keratitis is a significant cause of ocular morbidity and unilateral blindness worldwide. The incidence varies with various geographical location and is more common in tropical countries. They are the predominant type of infective corneal ulcers in South India. Identifying the fungal spectrum in each geographical location may help to choose the initial treatment. Aim of the study was to identify spectrum of fungi, to assess the response to the standard treatment given and to find out the sensitivity and specificity of KOH preparation in clinically diagnosed fungal corneal ulcers in patients attending a tertiary care centre in Kerala. METHODS All patients who are clinically diagnosed to have fungal corneal ulcer, based on history and slit lamp findings over a period of 2 years were included in the study. All patients were subjected to corneal scraping and the material is examined by KOH mounting and specific culture techniques as per standard microbiological techniques. The ulcer is treated as per the standard treatment protocol followed in the institution and the response to treatment was analysed. Out of the total 81 patients, Males predominated (n=57). KOH positivity was seen in 27 cases. The fungus culture was positive in 33 cases (41%). The sensitivity of KOH was 45.45% and specificity of 75%. The most common fungus isolated was Fusarium (72.72%) followed by Aspergillus (27.27%). The response to the treatment was good for cases in which Fusarium (75%) and Penicillium (100%) were isolated. The response to the treatment was poor in cases in which the culture report was negative; 56.25% cases developed complications. CONCLUSIONS Among the clinically diagnosed fungal corneal ulcer cases, 40% was found to be culture positive. The KOH preparation has a sensitivity of 45.45% in detecting fungus in mycotic corneal ulcers, whereas the specificity is 75%. Fusarium was the predominant fungus isolated. The response to the standard treatment protocol was better in fungal ulcers caused by Fusarium and Penicillium. The culture negative cases had a higher rate of complications.