Candida Keratitis: Epidemiology, Management, and Clinical Outcomes. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Qiao, Grace L.; Ling, Jennifer; Wong, Titus; Yeung, Sonia N.; Iovieno, Alfonso
• Is Part Of: Cornea. Volume 39:Issue 7(2020)
• Publication Date: 2020-07
• Subjects: Candida -- keratitis -- epidemiology -- fungi; Cornea -- Periodicals; Cornea -- Periodicals; Cornée -- Périodiques; 617.719
• DOI: 10.1097/ICO.0000000000002306
• Languages: English
• ISSNs: 0277-3740

Abstract

Abstract : Purpose: To examine the epidemiological characteristics, trends, risk factors, management strategies, and clinical outcomes of Candida albicans and non- albicans keratitis over a 15-year period in a tertiary Canadian eye center. Methods: In a retrospective observational case series of Candida keratitis from 2003 to 2017, demographics, risk factors, corrected distance visual acuity (CDVA) at initial and final consultations, medical and surgical management, and follow-up duration were recorded. Results: Twenty-one cases of Candida keratitis were identified (62.5% of total fungal keratitis; 10 C. albicans and 11 non- albicans ). The most commonly associated risk factors were topical steroid use (16 patients, 76%), ocular surface disease (15 patients, 71%), contact lens use (11 patients, 52%), and previous corneal surgery (8 patients, 38%); all patients had 2 or more combined risk factors. The number of patients with a visual acuity of 20/200 or better remained the same before and after the treatment (5/21, 24%). The mean duration of the antifungal treatment was 98 ± 126 days. Sixteen patients ultimately required surgical management (76%; 12 therapeutic keratoplasties, 3 enucleation, and 1 optical keratoplasty). When comparing C. albicans with non- albicans keratitis, we found no difference in presenting visual acuity, final visual acuity, or requirement for surgical management. Conclusions: Candida keratitis accounts for the most identified fungal keratitis cases in this temperate climate area. An exposure to multiple risk factors appears necessary. A surgical intervention is required for the resolution of most cases. Different subspecies of Candida ultimately resulted in similar clinical outcomes.