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  • Clinical profile, risk factors and outcome of medical, surgical and adjunct interventions in patients with Pythium insidiosum keratitis

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Clinical profile, risk factors and outcome of medical, surgical and adjunct interventions in patients with Pythium insidiosum keratitis
  1. Shweta Agarwal1,
  2. Geetha Iyer1,
  3. Bhaskar Srinivasan1,
  4. Saket Benurwar1,
  5. Mamta Agarwal1,
  6. Niveditha Narayanan1,
  7. Meena Lakshmipathy1,
  8. N Radhika1,
  9. Rama Rajagopal1,
  10. S Krishnakumar2,
  11. Lily Therese K3
  1. 1 CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India
  2. 2 L&T Ophthalmic Pathology Department, Vision Research Foundation, Chennai, Tamil Nadu, India
  3. 3 L&T Microbiology Research Centre, Vision Research Foundation, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Geetha Iyer, CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Chennai, Tamil Nadu, India; drgeethaiyer{at}gmail.com

Abstract

Purpose To report clinical profile and compare management options for Pythium keratitis.

Method Retrospective interventional study of 46 patients diagnosed as Pythium keratitis by PCR DNA sequencing from January 2014 to July 2017. Interventions were categorised into medical management (MM) (topical azithromycin and linezolid with oral azithromycin at presentation), surgery (S) (therapeutic penetrating keratoplasty, TPK), surgical adjunct (SA) (cryotherapy±alcohol with TPK) and medical adjunct (MA) (MM after TPK).

Results Primary treatment included MM (1 eye), SA (3 eyes) and S (42 eyes). Recurrence occurred in 27/43 eyes (MM+S group). Second surgery (S) was required in 11 eyes (TPK-2), with additional procedures (SA) in 10 eyes and evisceration in five eyes. 8/43 eyes received MA after TPK-1. One eye required TPK-3. Recurrence occured in all eyes that received MA (100%) and in 28 of 54 TPKs (51.8%) (TPK 1+2+3) in 42 eyes. Recurrence was noted in 1/14 (7.1%) that underwent SA.

Conclusion The currently available and recommended treatment for Pythium keratitis is surgical by means of a TPK and in worse cases evisceration. In our study, MM/MA measures showed no benefit with recurrence or worsening of infection requiring resurgery. Almost 50% of TPKs had a recurrence requiring resurgery. However, adjunctive procedures during TPK appear to have additional benefit with low risk of recurrence and could be included as routine care.

  • pythium keratitis
  • cryotherapy
  • refractory fungal keratitis
  • alcohol

https://doi.org/10.1136/bjophthalmol-2017-311804

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    Footnotes

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Institutional Review Board.

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