Candida species causing fungal keratitis: molecular identification, antifungal susceptibility, biofilm formation, and clinical aspects.

The study aimed to evaluate the clinical aspects, molecular identification, biofilm formation, and antifungal susceptibility profile of Candida species isolated from fungal keratitis. Thirteen Candida isolates from 13 patients diagnosed with Candida keratitis were retrieved and grown in pure culture. Species identification was performed by micromorphology analysis and ITS-rDNA sequencing. The broth microdilution method tested the minimum inhibitory concentration (MIC) of four antifungal drugs (fluconazole, amphotericin B, voriconazole, and anidulafungin). The biofilms were cultured and incubated with antifungal drugs for 24 h. The XTT reduction assay measured the biofilm activity. Biofilm MICs were calculated based on a 50% reduction in metabolic activity compared with the activity of the drug-free control. Among isolates, two were C. albicans, 10 were C. parapsilosis (sensu stricto), and one was C. orthopsilosis. All isolates were classified as susceptible or intermediate to all four antifungal drugs. Four isolates were very low biofilm producers (30%). Nine isolates were biofilm producers, and all biofilm samples were unsusceptible to all drugs tested. Previous ocular surgery was the most common underlying condition for fungal keratitis (84.6%), and C. parapsilosis was the most frequent Candida species (76.9%). Four patients (30.7%) needed keratoplasty, whereas two (15.3%) required evisceration. The biofilm formation ability of Candida isolates decreased antifungal susceptibility compared with planktonic cells. Despite in vitro antifungal susceptibility, almost half of the patients were unresponsive to clinical treatment and needed surgery.

Visual Field Characteristics of Type I Boston Keratoprosthesis Patients Without Glaucoma.

PURPOSE: To determine visual field findings in Boston type 1-KPro (BI-KPro) patients without glaucoma. Characterize normal threshold values and global indices using standard automated perimetry and characterize visual field amplitude using Goldmann's manual perimetry. METHODS: This cross-sectional prospective noninterventional study included patients (n=6 patients, 6 eyes) with BI-KPro who had normal optical coherence tomography and fundoscopic evaluation of the optic disc and retina. None had a previous history of glaucoma. Visual acuity, reliable and reproducible standard automated perimetry (24-2 and 30-2), and manual perimetry examinations were obtained from all patients. Each patient answered the National Eye Institute Visual Function Questionnaire, and the results were correlated with visual field indices. RESULTS: The mean visual acuity was 0.35±0.31 logMAR (0.84 to 0.10). All visual fields had good reliability indices. The standard automated perimetry mean deviation values were -7.25±3.63 decibels (dB) and -7.75±3.23 (24-2 and 30-2 values, respectively), whereas pattern SD values were 2.72±0.82 and 3.30±1.13 (24-2 and 30-2, respectively). The manual visual field mean values of the 4 quadrants (superior, temporal, inferior, and nasal), were 39.7±4.5, 61.8±6.2, 54.0±4.3, and 48.2±7.6 degrees, respectively. The authors found a significant correlation between the VFQ-25 indexes of general sight and close-range activities with the values of total deviation at 10 degrees. VFQ-25 peripheral vision indexes also correlated significantly with values of total deviation at 30 degrees (outermost locations in the 30-degree area). CONCLUSIONS: Patients with BI-KPro presented reliable and reproductive visual field measurements. The authors found a consistent reduction in visual field extension and a global sensitivity reduction in these patients. Despite visual field changes, our patients had a good quality of life scores. Overall, these results could be useful to improve early glaucoma diagnosis and to follow-up BI-KPro patients.