Purpose:

To evaluate the efficacy of the topical, systemic and targeted therapy (TST) protocol in management of fungal keratitis.

Method:

All cases of treatment-naive smear-or culture-proven fungal keratitis presenting between June 2013 and May 2017 were recruited. The TST protocol included initial treatment with topical natamycin 5% with addition of oral ketoconazole or voriconazole in ulcers with size> 5 mm, depth> 50%, or impending perforation. Topical voriconazole 1% was included in case of poor response at 7 to 10 days. Intrastromal or intracameral antifungal injections were administered in case of poor response to combination therapy. Penetrating keratoplasty was performed in case of poor response to any of the regimen.

Results:

The study included 223 cases of fungal keratitis with a mean age of 43.6±15.3 years and a male-to-female ratio of 1.8: 1. The mean area of the ulcer and infiltrate at presentation was 25.52±19 and 25.7±14.4 mm 2, respectively. Corrected distance visual acuity at presentation was 2.05±0.43 logMAR that improved to 1.6±0.4 logMAR at 3 months. Fusarium (42.2%) was the most common microorganism isolated, followed by Aspergillus (32.8%). The mean healing time was 41.5±22.2 days, with a final scar size of 14.6±8.2 mm 2. The treatment success rate with the TST protocol was 79.8%. Corneal perforation developed in 7% of cases (n= 15), and keratoplasty was performed for 20.2% of cases (n= 45).

Conclusions:

The TST protocol provides a stepwise treatment algorithm for management of cases of fungal keratitis with varying severity.