Media Centre

1 in 9 patients lose an eyeball to fungal eye infections in Pakistan

September 19 2017

126 (11%) of the 1,130 patients with fungal keratitis (keratomycoses) lost their eyeballs in a recent report of a prospective 11 years study conducted by Professor S.I.A. Shah and colleagues at Chandka Medical College and Hospital, Larkana, Pakistan, from March 2005 to March 2016. Over 50% of the remainder effectively lost their sight.

In this study to evaluate the post-treatment visual outcome of fungal keratitis, patients with compatible clinical features, with positive corneal scrapings for fungi, and those who were followed up for a minimum period of three months after recovery from infection were included. Other causes of infectious keratitis were excluded. Treatment included antifungal preparations, topical and if necessary systemic, in addition to symptomatic measures.

Patients were predominantly males (66%, 750) in the prime of life, mean age 39 (range: 16-74) years. Improvement in post-treatment visual acuity was seen in only 37% (416) of the patients; 590 (52%) of the eyes just retained visual acuity of not more than counting fingers and evisceration of the orbit was done in 126 (11%). Patients with residual corneal opacity needed keratoplasty, and the visual outcomes of these patients are not described.

Clinical care is quite compromised in small cities and rural settings in Pakistan. I understand that most of the patients included in this study belonged to very low socioeconomic background”. Dr. Afia Zafar. Professor Section of Microbiology, Department of Pathology and Laboratory Medicine, The Aga Khan University, Pakistan comments. Dr. David W. Denning, Professor of Infectious Diseases in Global Health at the University of Manchester added that “this is the worst clinical outcome I have ever seen in any published literature”.

Fungal keratitis is a major cause of infectious keratitis, usually occurring following direct (often traumatic) implantation of fungus into the cornea, infected contact lens, excessive ocular steroid use or in severely immunocompromised patients, associated with poor outcomes compared to bacterial or viral keratitis. Patients with fungal keratitis are at a greater risk of progressing to endophthalmitis and subsequent visual loss. Delayed treatment is complicated by complete corneal necrosis and perforation. The global burden of fungal keratitis is estimated at 1 million cases annually.

5% natamycin is the drug of choice for the treatment of fungal keratitis, especially Fusarium keratitis. It is superior to 1% topical voriconazole (Sharma et al, 2015).

Article: Visual outcome in patients of keratomycosis, at a tertiary care centre in Larkana, Pakistan