Retrospective Study of Fungal Keratitis in 412 Patients

Objective: To analyze the epidemiological features, laboratory examination methods and results and prognosis of fungal keratitis, in order to provide evidence for the diagnosis and treatment. Methods: This was a retrospective analysis review. The medical records of 412 cases (412 eyes) of fungal keratitis at Jizhong Energy Xingtai Mine Industrial Group General Hospital from January 2012 to December 2017 were analyzed with Kruskal-wallis H and so on of for epidemiological characteristics, clinical signs, etiology, diagnostic methods and results and prognosis, and the effect of treatment. Results: The peak period of fungal keratitis occurred in September to December, which accounted for 61.2% (252/412) of the annual total number of patients. The patients were mainly farmers, which accounted for 59.5% (245/412). One hundred eighty-five patients (44.9%) had an injury history related to plant injury, which was the primary cause, followed by non-plant injury in 86 patients (20.9%). The ratio of male to female was 1.82:1, the age was 14 to 81 years, the average age was 45.6±14.3 years, with 41-60 years accounting for 53.9% (222/412). The positive rate of fungal cultures was 88.8% (366/412), which was higher than the KOH wet-mount of 77.2% (318/412). The difference between the two detecting methods was statistically significant (χ2=31.14, P<0.001). The pathogenic bacteria were identified as follows: 167 cases (40.5%) of fusarium, 75 cases (18.2%) of alternaria genus, 62 cases (15.0%) of aspergillus genera, and 28 cases (6.9%) of penicillium. Typical clinical signs of fungal keratitis caused by mycelium moss were the most common (366 cases, 88.8%), followed by pseudopodia (224 cases, 54.4%) and hypopyon (111 cases, 26.9%). The differences in the severity classifications and prognosis of fungal keratitis caused by fusarium spp., alternaria spp., aspergillus spp. and penicilium spp. were statistically significant (Hc=40.676, P<0.001; Hc=40.109, P<0.001), and the disease classifications in fusarium and aspergillus were heavier than in alternaria and penicilliun. The prognosis was poor in alternaria and penicilliun. Conclusions: Fungal keratitis increases year by year, KOH wet-mount and fungal culture are effective diagnostic methods and fungal culture results are more reliable. In the first few pathogenic fungi, fungal keratitis caused by fusarium and aspergillus are serious, and the prognosis is not good, while cases of alternaria and penicillium are relatively mild with a good prognosis. Key words: fungal keratitis; epidemiology; clinical signs; species; prognosis