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Fungal keratitis management in a referral cornea center in Brazil / Manejo de ceratites fúngicas em centro de referência no Brasil
Bezerra, Fernanda Machado; Höfling-Lima, Ana Luisa; Oliveira, Lauro Augusto de.
  • Bezerra, Fernanda Machado; Universidade Federal de São Paulo. Department of Ophthalmology and Visual Sciences. Cornea and External Disease Sector. Sao Paulo. BR
  • Höfling-Lima, Ana Luisa; Universidade Federal de São Paulo. Department of Ophthalmology and Visual Sciences. Cornea and External Disease Sector. Sao Paulo. BR
  • Oliveira, Lauro Augusto de; Universidade Federal de São Paulo. Department of Ophthalmology and Visual Sciences. Cornea and External Disease Sector. Sao Paulo. BR
Rev. bras. oftalmol ; 79(5): 315-319, set.-out. 2020. tab, graf
Article in English | LILACS | ID: biblio-1137981
Responsible library: BR1.2
ABSTRACT
Abstract

Purpose:

To report etiological diagnosis, predisposing risk factors, therapeutic strategies and visual outcome of patients treated at the Department of Ophthalmology of Federal University of São Paulo.

Methods:

This is a retrospective, descriptive, and observational study from medical and laboratory records of the Department of Ophthalmology of Federal University of São Paulo, including all patients with culture proven fungal keratitis in 5 years, from October 2012 through October 2017.

Results:

There were 2260 fungi microbiologic test requests. Of these, 140 samples had positive cultures for fungi and sixty-six patients were followed at our clinic. Forty-five patients (68.2%) were men, and the mean age was 48.06 (±17.39) years. Fusarium spp. was the most frequently isolated fungus (32 cases; 48.5%), followed by Candida parapsilosis (12 cases; 18.2%). Thirty-four patients (51.5%) underwent intracameral injection of amphotericin B (5 µg per 0.1 ml). In 11 patients (32.3%), infection was eradicated after intracameral amphotericin B associated to topical antifungal treatment and, in 23 patients (67.7%), therapeutic keratoplasty was needed. No complication related to intracameral amphotericin B injection was observed in this series. Forty-three patients (65.1%) ended up with therapeutic keratoplasty. Three patients (4.5%) evolved to evisceration or enucleation. At the last follow-up visit, 53 patients (80.3%) had visual acuity worse than 20/200.

Conclusion:

Despite current antifungals drugs and distinct administration strategies, fungal keratitis remains challenging. Delayed antifungal therapy may explain poor clinical outcomes. Intracameral amphotericin B associated to topical antfungal treatment seems to be a safe and helpful alternative for non-responsive fungal keratitis. But it is important to formulate other treatment strategies, hence to improve patients' outcomes, since most patients ended-up with significant visual impairment even after current treatment.
RESUMO
Resumo

Objetivo:

Descrever diagnósticos etiológicos, fatores de risco, estratégias terapêuticas e resultados visuais de pacientes com ceratite fúngica tratados no Departamento de Oftalmologia da Universidade Federal de São Paulo.

Métodos:

Trata-se de um estudo retrospectivo, descritivo e observacional, a partir da análise de prontuários médicos e laboratoriais do Departamento de Oftalmologia da Universidade Federal de São Paulo, incluindo todos os pacientes com ceratite fúngica comprovada por cultura no período de outubro de 2012 a outubro de 2017.

Resultados:

Foram realizadas 2260 solicitações de testes microbiológicos. Destas, 140 amostras apresentaram culturas positivas para fungos, e 66 pacientes foram acompanhados em nosso serviço. Quarenta e cinco pacientes (68,2%) eram do sexo masculino, e a média de idade foi de 48,06 (± 17,39) anos. Fusarium spp. foi o fungo mais freqüentemente isolado (32 casos; 48,5%), seguido por Candida parapsilosis (12 casos; 18,2%). Trinta e quatro pacientes (51,5%) foram submetidos à injeção intracameral de anfotericina B (5 µg por 0,1 ml). Destes, 11 pacientes (32,3%) tiveram a infecção erradicada. Nos outros 23 pacientes (67,7%), o transplante terapêutico foi necessário. Nenhuma complicação relacionada à injeção intracameral de anfotericina B foi observada neste estudo. No total, 43 pacientes (65,1%) evoluíram para transplante terapêutico, e 3 pacientes (4,5%) foram submetidos à evisceração ou enucleação. Cinquenta e três pacientes (80,3%) apresentaram acuidade visual final pior que 20/200.

Conclusões:

Apesar dos diversos medicamentos antifúngicos atuais e vias de administração, o tratamento das ceratites fúngicas permanece desafiador. O atraso no início do tratamento adequado pode justificar o desfecho clínico desfavorável de grande parte dos pacientes. A injeção intracameral de anfotericina B mostrou-se uma alternativa terapêutica segura para ceratites fúngicas refratárias. Mas outras estratégias de tratamento devem ser formuladas, visando melhorar os resultados visuais dos pacientes.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Eye Infections, Fungal / Amphotericin B / Corneal Transplantation / Candida parapsilosis / Fusarium / Keratitis / Antifungal Agents Type of study: Risk factors Limits: Adolescent / Adult / Aged / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Rev. bras. oftalmol Journal subject: Ophthalmology Year: 2020 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Eye Infections, Fungal / Amphotericin B / Corneal Transplantation / Candida parapsilosis / Fusarium / Keratitis / Antifungal Agents Type of study: Risk factors Limits: Adolescent / Adult / Aged / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Rev. bras. oftalmol Journal subject: Ophthalmology Year: 2020 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal de São Paulo/BR