期刊
JOURNAL OF FUNGI
卷 8, 期 10, 页码 -出版社
MDPI
DOI: 10.3390/jof8101067
关键词
microbial keratitis; fungal keratitis; management; antifungals; microbiology; natamycin; chlorhexidine
资金
- [207472/Z/17/Z]
Filamentous fungal keratitis is difficult to treat, and the first-line treatment is usually topical natamycin. Surgical therapy may be required for severe cases, and alternative treatments are not always effective.
Filamentous fungal infections of the cornea known as filamentous fungal keratitis (FK) are challenging to treat. Topical natamycin 5% is usually first-line treatment following the results of several landmark clinical trials. However, even when treated intensively, infections may progress to corneal perforation. Current topical antifungals are not always effective and are often unavailable. Alternatives topical therapies to natamycin include voriconazole, chlorhexidine, amphotericin B and econazole. Surgical therapy, typically in the form of therapeutic penetrating keratoplasty, may be required for severe cases or following corneal perforation. Alternative treatment strategies such as intrastromal or intracameral injections of antifungals may be used. However, there is often no clear treatment strategy and the evidence to guide therapy is often lacking. This review describes the different treatment options and their evidence and provides a pragmatic approach to the management of fungal keratitis, particularly for clinicians working in tropical, low-resource settings where fungal keratitis is most prevalent.
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