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Susceptibility testing and clinical outcome in fungal keratitis
  1. Brett L Shapiro1,
  2. Prajna Lalitha2,
  3. Allison R Loh1,3,
  4. Annette W Fothergill4,
  5. Namperumalsamy V Prajna2,
  6. Muthiah Srinivasan2,
  7. Amit Kabra2,
  8. Jaya Chidambaram1,
  9. Nisha R Acharya1,
  10. Thomas M Lietman1
  1. 1F.I. Proctor Foundation, University of California, San Francisco, California, USA
  2. 2Aravind Eye Hospitals, Madurai, India
  3. 3University of Pennsylvania School of Medicine, Philadelphia, USA
  4. 4University of Texas Health Sciences Center at San Antonio, Texas, USA
  1. Correspondence to Dr Thomas M Lietman, F.I. Proctor Foundation, Room S309, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143, USA; tom.lietman{at}ucsf.edu

https://doi.org/10.1136/bjo.2009.158675

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    Fungal keratitis causes significant morbidity, especially in tropical climates, and is notoriously difficult to manage. The choice of antifungal agent for fungal keratitis remains largely empirical, with no consensus on the role of susceptibility testing in guiding therapy. Studies suggest that susceptibility and outcome may be associated in systemic fungal infections with some dimorphic fungi,1 but this correlation may not exist for filamentous fungi or in ocular disease because of frequent topical dosing and high drug concentration. Given the availability of new topical medications, tailoring antifungal therapy based on microbial sensitivity is important.2 Here, we assess whether fungal susceptibility testing correlates with clinical outcomes in cases of fungal keratitis.

    Methods

    This study was a retrospective case review of consecutive patients with culture proven fungal keratitis presenting to the Aravind Eye Hospital cornea clinic between March and July 2004. Of 98 consecutive patients, minimum inhibitory concentration (MIC) data was available for 90.3 Eighty-one corresponding charts were available, and 54 charts had follow-up of at least 3 weeks to allow determination of healing. All cases were …

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    Footnotes

    • Funding The funding for this research was provided by the National Eye Institute, EY02162, That Man May See, the South Asia Research Fund and the Doris Duke Charitable Foundation. The funding organisations played no role in the design, collection, analysis and/or interpretation of data, writing or submission of the paper.

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of the institutional review boards at Aravind Medical Research Foundation and University of California San Francisco (CHR #H9332-21899-01).

    • Provenance and peer review Not commissioned; externally peer reviewed.