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Lee, Chae, and Yoon: Analysis of Risk Factors for Treatment Failure in Fungal Keratitis
Original Article

J Korean Ophthalmol Soc 2008;49(5):737-742.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.5.737

Analysis of Risk Factors for Treatment Failure in Fungal Keratitis

Kwang Hoon Lee, M.D.1, Hong Jae Chae, M.D.2, Kyung Chul Yoon, M.D.1

1Department of Ophthalmology, Chonnam National University Medical School & Hospital, Gwangju, Korea

2Occupational Environment Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, M.D. Department of Ophthalmology, Chonnam National University Medical School & Hospital #8 Hak-dong, Tong-gu, Gwang-ju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 10 August 2007       Accepted 27 December 2007

Copyright © 2008 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the risk factors for treatment failure in fungal keratits.

Methods

A total of 109 patients with fungal keratitis, who were diagnosed by clinical findings, smears, and cultures and followed up for at least 2 months, were studied retrospectively. Age, sex, previous history of trauma, systemic diseases, corticosteroid use, previous ocular disease, features of keratitis, causative organism, and treatment results were reviewed. An initial univariate and multivariate logistic regression analysis was performed to identify and select the main prognostic risk factors.

Results

Treatment was successful in 76 patients (69.7%) and failed in 33 patients (30.3%). Fusarium species was isolated in 34 eyes (40.0%), and an ulcer lesion was located in the central area of 54 eyes (49.5%). Multivariate analysis demonstrated that predictors of treatment failure were an ulcer exceeding 10 mm2 (P<0.001) and the presence of previous ocular diseases (P=0.007).

Conclusions

In patients with fungal keratitis, a large ulcer size and the presence of other ocular diseases were risk factors for treatment failure.

Keywords: Fungal keratitis, Risk factor, Treatment failure

References

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Table 1.
Distribution of patients with fungal keratitis according to treatment results
Characteristics at Diagnosis N Treatment Success (n=76)(%) Treatment Failure (n=33) (%)
Trauma 61 48 (63.2) 13 (39.4)
 Sand / Mud 7 5 (6.6) 2 (6.1)
 Plant 35 28 (36.8) 7 (21.2)
 Stone 5 4 (5.3) 1 (3.0)
 Finger 1 1 (1.3) 0 (0.0)
 Others (Dust, Iron etc) 13 10 (13.2) 3 (9.1)
Previous ocular disease 26 13 (17.1) 13 (39.4)
 HSK 4 1 (1.3) 3 (9.1)
 Corneal Opacity 10 7 (9.2) 3 (9.1)
 Facial Palsy / Lagophthalmos 8 4 (5.3) 4 (12.1)
 Cicatricial Ectropion 1 0 (0.0) 1 (3.0)
 Hansen 1 1 (1.3) 0 (0.0)
 Scleritis 1 0 (0.0) 1 (3.0)
 Symblepharon 1 0 (0.0) 1 (3.0)
Previous ocular surgery 9 6 (7.9) 3 (9.1)
 Cataract Surgery 5 5 (6.6) 0 (0.0)
 Keratoplasty 2 0 (0.0) 2 (6.1)
 Pterygium Surgery 2 1 (1.3) 1 (3.0)
Table 2.
Comparison of patient characteristics between the treatment success and failure group
Characteristics at Diagnosis Treatment Success Treatment Failure P
Age (yrs) 61.80±14.06 63.06±7.95 0.555
Pretreatment symptom duration (days) 10.14±17.42 8.70±11.92 0.617
Ulcer size (mm2) 10.15±10.20 23.52±20.84 0.001
Hypopyon height (mm) 0.41±0.67 0.87±0.97 0.016
Initial visual acuity (LogMAR) 1.83±1.13 2.69±0.65 <0.001
Final visual acuity (LogMAR) 1.33±1.16 3.05±0.55 <0.001
Treatment success time (days) 30.57±26.87 110.00±38.19 0.009
Table 3.
Prognostic factors for treatment failure in fungal keratitis
Risk Factors No. of patients (%) Odds Ratio 95% CI P value
Age        
 > 40 33/103 (32.03) 1.47 1.29-1.68 0.097
 ≤ 40 0/6 (0)      
Gender        
 Male 18/61 (29.51) 1.09 0.48-2.47 0.844
 Female 15/48 (31.25)      
Trauma        
 Present 13/61 (21.31) 2.64 1.14-6.11 0.022
 Absent 20/48 (41.67)      
Diabetes mellitus        
 Present 2/5 (40.0) 1.57 0.25-9.86 0.638
 Absent 31/104 (29.81)      
Previous ocular disease        
 Present 13/26 (50.0) 3.15 1.257-7.894 0.012
 Absent 20/83 (24.10)      
Recent corticosteroids        
 Present 14/34 (41.18) 2.06 0.87-4.87 0.095
 Absent 19/75 (25.33)      
Hyphae        
 Present 11/34 (32.35) 1.15 0.48-2.76 0.751
 Absent 22/75 (29.33)      
Infiltration        
 Superficial 9/59 (15.25) 5.13 2.08-12.62 <0.001
 Deep 24/50 (48.0)      
Size of ulcer (mm2)        
 > 10 25/49 (48.98) 6.77 2.67-17.19 <0.001
 ≤ 10 8/60 (13.33)      
Hypopyon        
 Present 25/57 (43.86) 4.30 1.72-10.75 0.001
 Absent 8/52 (15.38)      
Culture result        
 Positive 30/85 (35.29) 3.82 1.05-13.86 0.043
 Negative 3/24 (12.5)      
Fungal genus        
 Fusarium 16/34 (47.06) 2.35 0.94-5.85 0.064
 Others 14/51 (27.45)      
Table 4.
Prognostic factors for treatment failure in fungal keratitis (Multivariate Analysis)
Variables in Regression Model Odds Ratio 95% CI∗ P-value
Size of ulcer (>10 mm2 vs. ≤10 mm2) 10.31 3.13-33.33 <0.001
Previous ocular disease 6.45 1.67-25.00 0.007

∗ CI = confidence interval.

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