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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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  • Funding None of the authors has any financial disclosures related to this manuscript. This research was funded by That Man May See and the South Asia Research Fund. The Department of Ophthalmology at UCSF is supported by a core grant from the National Eye Institute, EY02162. Dr Acharya is supported by a National Eye Institute K23EY017897 grant and a Research to Prevent Blindness Career Development Award. Dr Lietman is supported by a National Eye Institute grant U10-EY015114 and a Research to Prevent Blindness award. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of California, San Francisco; Aravind Eye Hospital, Madurai, India; Dartmouth-Hitchcock Medical Center, Hanover, NH.

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