Fungal Keratitis in a Tertiary Hospital in Malaysia

Abstract

Background Fungal keratitis is one of the commonest causes of corneal blindness in developing countries including Malaysia. We aim to evaluate the sociodemographic background, clinical features, predisposing factors, laboratory findings, management, complications, and visual outcome of patients with fungal keratitis in a tertiary hospital in Malaysia. Methods A retrospective review of medical and microbiology records of all patients treated for corneal ulcer from 2015 to 2019 at Hospital Sultanah Bahiyah was performed. Sociodemography, predisposing risk factors, clinical characteristics, causative organisms, and final visual outcome were analyzed. Results We identified 103 patients with a diagnosis of fungal keratitis. The majority of the patients were of Malay ethnicity (85.4%) and male gender (81.6%), with an age range of 21 to 60 years (94.1%). Ocular trauma was the main predisposing factor in 82 (79.6%) patients. Poor visual improvement was observed in groups with ulcer more than 4mm (67.5%), presence of hypopyon (50.9%), and high intraocular pressure (75.0%) upon presentation. Fusarium spp. (19.4%) was the commonest fungus isolated followed by Aspergillus spp. (5.8%). All patients were prescribed either topical, oral, intracameral, or combined therapy, whereas 20 (19.4%) patients required surgical intervention, of which 16 (15.5%) underwent penetrating keratoplasty and three (2.9%) required evisceration. Conclusion The epidemiological, socioeconomic, and predisposing factors may facilitate timely diagnosis and prompt treatment to achieve a better visual outcome and minimize complications including corneal blindness.