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Clinical signs in dematiaceous and hyaline fungal keratitis
  1. Catherine E Oldenburg1,
  2. Venkatesh N Prajna2,
  3. Lalitha Prajna2,
  4. Tiruvengada Krishnan2,
  5. Jeena Mascarenhas2,
  6. C M Vaitilingam2,
  7. Muthiah Srinivasan2,
  8. Craig W See1,
  9. Vicky Cevallos1,
  10. Michael E Zegans3,
  11. Nisha R Acharya1,
  12. Thomas M Lietman1
  1. 1F.I. Proctor Foundation, University of California San Francisco (UCSF), San Francisco, California, USA
  2. 2Aravind Eye Care System, Madurai and Pondicherry, India
  3. 3Department of Surgery (Ophthalmology), Dartmouth Medical School, Hanover, New Hampshire, USA
  1. Correspondence to Professor Thomas M Lietman, F.I. Proctor Foundation, Room S309, 513 Parnassus Avenue, UCSF, San Francisco, CA 94143-0412, USA; tom.lietman{at}

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Filamentous fungi are important aetiological agents of keratitis globally.1 Hyaline hyphomycetes including Fusarium and Aspergillus spp. are most common, but dematiaceous fungi such as Curvularia and Bipolaris spp. constitute approximately 20% of cases.2 3 Commonly reported signs of fungal keratitis include feathery edges, raised lesions, hypopyon, stromal infiltrates and, less frequently, satellite lesions and ring infiltrates.1 In dematiaceous cases, reported characteristics include raised lesions and macroscopic pigmentation.4 5 In this report, we analyse clinical signs of fungal keratitis, comparing hyaline and dematiaceous fungi, and the hyaline fungi Fusarium and Aspergillus spp.


Clinical examination and microbiological reports were collected prospectively in a clinical trial setting. Methods for the trial have been described previously.6 In brief, eligible cases had evidence of filamentous fungus on Gram stain and/or potassium hydroxide. Scrapings were inoculated onto sheep's blood agar, chocolate agar and potato dextrose agar. Fungal cultures were deemed positive with growth on two media or moderate to heavy growth on one media.

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