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ID: 287 Fusarium keratitis in a tertiary eye care centre in India Sujata Das, MS, FRCS L V Prasad Eye Institute Bhubaneswar, India, 751024 [email protected] Savitri Sharma, MD Samir Mahapatra, MS Srikant K Sahu, MS Authors do not have any financial or conflicting interests to disclose ID: 287 Introduction Fungal keratitis continues to be a cause of concern to ophthalmologists. It accounts for 30 to 50% of all cases of microbial keratitis in developing countries.# Increased awareness coupled with improved laboratory and in vivo diagnostic techniques have led to an increase in the frequency of correct diagnosis and consequent increase in prevalence of the disease.@ # # # # @ @ Srinivasan M, et al. Br J Ophthalmol 1997; 81: 965-971. Gopinathan U, et al. Cornea 2002; 21: 555-559. Dunlop AA, et al. Aust N Z J Ophthalmol 1994; 22: 105-110. Hagan M, et al. Br J Ophthalmol 1995; 79: 1024-1028. O’Brien TP, Rhee P. In Textbook of Ocular Pharmacology. Hagerstown: Lipincott-Raven, 1997: 587-607. O’Day D. In Ocular Infection and Immunity. St Louis: Mosbey, 1996: 1048-1061. ID: 287 Introduction The epidemiological features of fungal keratitis vary across geographic regions and climatic conditions. Fungal keratitis occurs more frequently in warm, and dry climate than in temperate zones. Fusarium and Aspergillus species are the most common fungi isolated from patients in tropical regions. The purpose of the study was to report clinical and microbiological profile of Fusarium keratitis. ID: 287 Material and Methods A retrospective analysis of medical records was done to study the clinical and microbiological profile of 42 consecutive culture-proven Fusarium keratitis patients presented at the corneal unit of L V Prasad Eye Institute, Bhubaneswar, between November 2006 & July 2009. The following data were collected from each record: age, sex, predisposing risk factor, clinical presentation, microbiological result, mode of management, and final outcome. All patients had undergone detailed clinical evaluation and slit-lamp examination. ID: 287 Material and Methods As a part of standard protocol, corneal scrapings were obtained from all microbial keratitis and subjected to the following : Placing on glass slide Smearing on glass slides Gram BA (O2+) BA (O2-) CA (CO2) BHI Thio SDA PDA NNA ( E. coli ) ID: 287 Clinical Picture ID: 287 Results Mean age of patients was 47±17 (range: 4-95, median: 45) years. Eleven eyes (26.2%) had history of injury. Mean duration of symptom was 17±14 (range: 3-60, median: 10) days. Hypopyon was present in 15 (35.7%) cases. Satellite lesion was not present in any eye. 57.14% 42.86% ID: 287 Results Thirty six (85.7%) cases were smear-positive for fungus. In 3 cases microconidia was observed in direct smear examination. Fusarium solani was the most common (45.2%) fungi. Five patients had associated bacterial infection. All 3 cases where microconidia was present in direct smear examination were identified as Fusarium solani in culture. The mean time to positive culture was 1.8±1 days. ID: 287 Microbiological Examination Giemsa 1000 BA CA SDA ID: 287 Adventitious Sporulation CFW 200 LCPB 400 Gram 1000 Gram 1000 ID: 287 Results Twenty one (50%) patients underwent adjunctive surgical procedure • Tissue adhesive application : n = 9; • Therapeutic penetrating keratoplasty : n = 13; • Anterior chamber wash + Intracameral antifungal : n = 4; • Evisceration : n = 3. 16.7% and 41.5% patients had visual acuity of <20/200 during presentation and final follow-up respectively. Eighteen patients had improvement in visual acuity. ID: 287 Conclusion Fusarium keratitis may present after trauma without any satellite lesion and needs surgical intervention in 50% cases. Smears of corneal scrapings often disclosed hyphae, and culture media showed growth within 3 days. Microconidia in smear examination may be suggestive of Fusarium solani.