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

A healthy 27-year-old woman with a corneal ulcer underwent fibrin gluing with a bandage contact lens twice, due to an impending perforation. The ulcer lesion slowly progressed, unresponsive to topical antibiotics and amphotericin B. We removed the gluing patch and performed a corneal or scraping or biopsy with multiple amniotic membrane grafts to seal the thinned or perforated cornea. Three days after the surgery, the corneal cultures grew Fusarium, as well as Enterococcus faecalis. Three weeks after surgery, the outermost layer of amniotic membranes, serving as a temporary patch, was removed. The anterior chamber was clear without cells. The signs of infection clinically and symptomatically cleared up four weeks later. Two months after surgery, the lesion became enhanced by amniotic membranes. The use of fibrin glue in infectious keratitis should be avoided, because it not only masks the underlying lesion, but it also interferes with drug penetration into the underlying lesion.
Adult ; Corneal Perforation/*drug therapy ; Corneal Ulcer/*drug therapy/*microbiology ; Eye Infections, Fungal/*microbiology ; Female ; Fibrin Tissue Adhesive/*therapeutic use ; Fusariosis/*microbiology ; Fusarium/*isolation & purification ; Humans

Colletotrichum is mainly a fungal pathogen of plants, but sporadic cases of human infection have been reported recently. Most of them are fungal keratitis and only a few cases have been reported worldwide. A 63-year-old female farmer developed foreign body sensation and watering in her left eye following trauma by rice leaves. At presentation, her visual acuity decreased and corneal ulcer and inflammation in anterior chamber were observed on a slit lamp examination. Numerous hyphae were found on Gram stain and a rapidly growing mold with cup-shaped acervuli and falcate and nonseptate conidia was observed on fungal culture. As morphological findings did not lead to definite differentiation of the organism, sequencing of the D1-D2 domain of 28S rDNA was performed. It proved to be Colletotrichum species and the patient was treated with amphotericin and natamycin eye drop, but complicated by acute glaucoma. This is the first report of Colletotrichum keratitis in Korea and suggests that its infection should be considered in patients with fungal keratitis.
Amphotericin B ; Anterior Chamber ; Colletotrichum* ; Corneal Ulcer ; DNA, Ribosomal ; Female ; Foreign Bodies ; Fungi ; Glaucoma ; Humans ; Hyphae ; Inflammation ; Keratitis* ; Korea ; Middle Aged ; Natamycin ; Sensation ; Spores, Fungal ; Visual Acuity ; Water

INTRODUCTIONThis study was conducted to determine the epidemiological pattern and risk factors associated with corneal ulcers in rural areas of western Maharashtra, India, and to identify the bacterial and fungal agents responsible for causing keratitis.

METHODSA total of 852 patients with corneal ulceration were included in the study. Sociodemographic data and information pertaining to risk factors were collected. Corneal scrapings obtained from these patients were processed for bacterial and fungal agents using standard techniques.

RESULTSOut of the 852 patients studied, 537 (63.02%) were culture positive. A majority of the culture-positive patients were farmers (52.32%), and ocular trauma was the most common predisposing factor (60.15%). Among these patients, fungal isolates (57.91%) were more frequent than bacterial isolates (42.08%). The most common fungal isolate was Fusarium spp. (35.04%) followed by Aspergillus spp. (18.00%). Streptococcus pneumoniae was the predominant bacterial isolates (32.74%) followed by Staphylococcus spp. (17.25%).

CONCLUSIONCorneal trauma from plant parts or organic matter was found to be the most common risk factor associated with corneal ulceration in the rural areas of western Maharashtra. Epidemiology and aetiology of microbial keratitis vary from region to region, and therefore, careful history taking and proper identification of aetiological agents are necessary for the institution of appropriate therapy.

Adult ; Cornea ; microbiology ; Corneal Ulcer ; epidemiology ; microbiology ; Eye Infections, Bacterial ; epidemiology ; microbiology ; Eye Infections, Fungal ; epidemiology ; microbiology ; Female ; Hospitals, Rural ; Humans ; India ; epidemiology ; Male ; Risk Factors ; Young Adult