Fungal corneal ulcer could lead to a devastating outcome. The relative scarcity of readily available, inexpensive but effective topical antifungal drug has left many ophthalmologists desperate and frustated in treating the condition. The use of oral itraconazole has long been proven to be of clinical value in a number of forms of mycoses. Its safety profile is extremely good with minimal reported adverse effects. We investigated an aqueous form of itraconazole which we prepared into a 0.1 mg/ml concnetration and compared its efficacy as a topical antifungal against the standard drug. Natamycin 5 percent in the treatment of fungal keratitis in rabbits. A randomized animal trial was done using 24 rabbit eyes divided into 2 treatment groups. All rabbit corneas were inoculated with Aspergillus flavus and treated after 48 hours with either Topical itraconazole or Natamycin 5 percent for a period of 2 weeks. Results showed inhibition of the disease with both treatment groups. We also found no significant difference between the severity, progression and remission of the keratitis between both treatment groups clinically and statistically. Topical itraconazole 0.1 mg/ml was shown to be comparable to our standard topical antifungal Natamycin 5 percent in treating fungal keratitis. (Author)
Animal ; ASPERGILLUS KERATITIS ; OPHTHALMOLOGY ; ASPERGILLUS FLAVUS ; NATAMYCIN ; ITRACONAZOLE ; FUNGAL CORNEAL ULCER ; FUNGAL KERATITIS

PURPOSE: To measure the secretion of IL-8 from cultured human keratocytes after inoculation of conidia of A. fumigatus, and to compare the change of secretion of IL-8 following application of amphotericin B and dexamethasone. METHODS: Human corneal keraoctytes were cultured independently in vitro. The specimens were divided into 4 groups : Group I with only pure culture as control, Group II with conidia of A. fumigatus, Group III with conidia of A. fumigatus and amphotericin B, and Group IV with conidia of A. fumigatus and dexamethasone. The supernatants were aspirated from each group at different time intervals, and then were assayed for IL-8. RESULTS: Group II showed increased secretion of IL-8, at all selected time intervals except 12-h, in comparison with other three groups. Group III secreted IL-8 significantly less than the other groups(p<0.01). Group IV secreted IL-8 less than Group I and II at all selected time points(p<0.01), but more than Group III at the other time points except for 72-h(p<0.01). CONCLUSIONS: The secretion of IL-8 increased in the early stage of fungal keratitis but decreased in case of the administration of amphotericin B or dexamethasone. Amphotericin B was more potent than dexamethasone in decreasing the secretion of IL-8.
Amphotericin B* ; Aspergillus fumigatus* ; Aspergillus* ; Dexamethasone* ; Humans* ; Interleukin-8* ; Keratitis ; Spores, Fungal

Stenotrophomonas maltophilia keratitis is rare and none of it has been reported to be combined with Aspergillus keratitis.I have experienced a corneal ulcer caused by combined infection of S.maltophilia and A. fumigatus.S. maltophilia was grown on culture and a brownish pigmented anterior chamber mass containing filamentous fungi was attached to corneal ulcer area endothelium without the usual filamentous fungal keratitis findings such as feathery edge, satellite lesions, endothelial plaques, etc. A spergillusfumigatus was grown on culture of abscess which developed along the superior incision for removal of anterior chamber mass.
Abscess ; Anterior Chamber ; Aspergillus fumigatus* ; Aspergillus* ; Corneal Ulcer* ; Endothelium ; Fungi ; Keratitis ; Stenotrophomonas maltophilia* ; Stenotrophomonas*

The concentration of clotrimazole in the cornea considering the lapse of time after topical administration of 1% clotrimazole, in a single drop or 13 drops at an interval of 5 minutes, was evaluated by agar diffusion bioassay, The rabbits were divided into 3 groups: normal cornea, deepithelized cornea and Aspergillus keratitis, In the case of a single dose, the drug concentration in the normal cornea was lower than the value which can be measured, and the concentration in deeptithelized cornea was significantly higher than in keratitis(p<0.05). In the case of multiple doses, the drug concentration in keratitis was higher than in the deepitheHzed cornea and both of these were higher than in the norma cornea. EspeciaUy the group of keratitis had a significantly higher level(p<0.05) and an abrupt decrease of the drug concentration than the group of deepithelized cornea. This result means that the cornea during inflammation has increased permeability and great metabolic activity. In general the drug concentration in all groups except a single dose in the normal cornea was higher than minimal inhibitory concentration of clotrimazole against A. fumigatus, and this result suggests that the topical administration of 196 dotrimazole is likely to be efficacious in the treatment of Aspergillus keratitis.
Administration, Topical* ; Agar ; Aspergillus ; Biological Assay ; Clotrimazole* ; Cornea* ; Diffusion ; Inflammation ; Keratitis ; Permeability ; Rabbits*

Photoablation with 193-nm excimer laser was performed on the corneal infiltration after induction of experimental Candida albicans keratitis and Aspergillus fumigatus keratitis in rabbits in order to evaluate the therapeutic effect of excimer laser. The excimer laser eradicated the corneal infiltration in all eight eyes of the C, albicans group. In the A, fumigatus group, two corneas were perforated during treatment and one cornea left the fungal hyphae in the deep corneal stroma after treatment. Though it cannot remove the hyphae completely in the deeply invaded fungal keratitis because of corneal perforation during treatment, excimer laser photoablation may be an effective technique to eradicate early, localized, superficial fungal keratitis.
Aspergillus fumigatus ; Candida albicans ; Cornea ; Corneal Perforation ; Corneal Stroma ; Hyphae ; Keratitis* ; Lasers, Excimer* ; Rabbits

PURPOSE: To present a case report of fungal keratitis related to prolonged overnight use of orthokeratology contact lenses. METHODS: A 13 year-old girl presented with a corneal ulcer in her left eye refractory to antibacterial medication. She had a history of wearing orthokeratology contact lenses overnight for seven months. RESULTS: The organism Aspergillus was isolated by corneal scraping, the contact lens itself, and from the storage case. The patient was treated with topical fluconazole and Natamycin pimaricin in addition to oral itraconazole, resulting in a resolution of the ocular lesion. CONCLUSIONS: The risk of fungal infection as a potential complication of the use of overnight orthkeratology contact lenses should be considered when using these lenses.
Adolescent ; Aspergillus ; Contact Lenses ; Corneal Ulcer ; Female ; Fluconazole ; Humans ; Itraconazole ; Keratitis* ; Natamycin

BACKGROUND: Clinical concern and incidence of mycotic keratitis in ophthalmic practice has been increasing. OBJECTIVE: The purpose of this study was to investigate clinical and mycological feature of mycotic keratitis. METHODS: We evaluated the clinical and mycological aspect of mycotic keratitis in 14 patients from October 1993 to March 1997 in Dongguk Unversity Hospital. RESULTS AND CONCLUSION: Mycotic keratitis showed high incidence in fifth (42.9%), sixth (35.7%), and fourth decade (14.3%). The ratio of male to female patient was 1:3.6. The seasonal prevalence was highest in autumn. A scratch or abrasion from vegetation was the most common type of the eye trauma in mycotic keratitis. The positive rate of KOH examination and culture was 92.9%, respectively. The common causative organisms of mycotic keratitis were Fusarium sp. (38.5%) and Alternaria sp. (38.5%), followed by Curvularia sp. (7.7%), Aspergillus flavus (7.7%) and Acremonium sp. (7.7%).
Acremonium ; Alternaria ; Aspergillus flavus ; Female ; Fusarium ; Humans ; Incidence ; Keratitis* ; Male ; Prevalence ; Seasons

Aspergillus fumigatus ; Cytokines ; Humans ; Interleukin-1beta ; Keratitis ; Receptors, IgE ; Tumor Necrosis Factor-alpha ; Tumor Necrosis Factors

BACKGROUND: Fungal keratitis is common cause of corneal infection. If not diagnosed and treated promptly and effectively, significant damage can occur. OBJECTIVE: To investigate the clinical manifestations and risk factors for treatment failure in fungal keratitis. METHODS: A total of 23 patients with fungal keratitis, who were diagnosed by clinical findings, smears, and cultures and followed up for at least 6 months, were studied retrospectively. Age, sex, previous history of trauma, corticosteroid use, previous ocular disease and surgery, systemic diseases, causative organism, features of keratitis, and treatment results were reviewed. A logistic regression analysis was performed to identify the prognostic risk factors. RESULTS: Thirteen patients (57%) were male and mean age was 57 +/- 18 years. Trauma with vegetable matter (30%) was most commonly noted. The causative organisms were identified in 18 eyes (78%) and Aspergillus sp. (7 eyes, 30%) was the most common detected followed by Candida sp. (6 eyes, 26%), Fusarium sp. (3 eyes, 13%) and Penicillium sp. (2 eyes, 9%). A lesion located in the central area was 13 eyes (57%) and exceeding 10 mm2 in size was 15 eyes (65%). Hypopyon was found in 7 eyes (30%). Treatment failed in 9 eyes (39%), and predictor of treatment failure was a lesion exceeding 10 mm2 (p < 0.05). CONCLUSION: Risk factor for treatment failure included a large lesion size. Therefore, an effort should be made to discern the clinical features of fungal keratitis and to determine appropriate early treatment for a successful treatment outcome.
Aspergillus ; Candida ; Fusarium ; Humans ; Keratitis* ; Logistic Models ; Male ; Penicillium ; Retrospective Studies ; Risk Factors* ; Treatment Failure* ; Treatment Outcome ; Vegetables

PURPOSE: To present a case report of fungal keratitis related to prolonged overnight use of orthokeratology contact lenses. METHODS: A 13 year-old girl presented with a corneal ulcer in her left eye refractory to antibacterial medication. She had a history of wearing orthokeratology contact lenses overnight for seven months. RESULTS: The organism Aspergillus was isolated by corneal scraping, the contact lens itself, and from the storage case. The patient was treated with topical fluconazole and Natamycin pimaricin in addition to oral itraconazole, resulting in a resolution of the ocular lesion. CONCLUSIONS: The risk of fungal infection as a potential complication of the use of overnight orthkeratology contact lenses should be considered when using these lenses.
Aspergillus ; Contact Lenses ; Corneal Dystrophies, Hereditary ; Corneal Ulcer ; Eye ; Fluconazole ; Humans ; Itraconazole ; Keratitis ; Keratomileusis, Laser In Situ ; Natamycin