Outcomes of Treatment of Fungal Keratitis at the University of Iowa Hospitals and Clinics: A 10-Year Retrospective Analysis

PURPOSE:To evaluate the outcomes of medical and surgical management of fungal keratitis at a tertiary care eye center. METHODS:A retrospective review was performed of the medical records of all patients with a diagnosis of microbiologically or histopathologically confirmed fungal keratitis at the University of Iowa Hospitals and Clinics from July 1, 2001, through June 30, 2011. The main outcome measure was a microbiological cure with either medical therapy alone or medical therapy combined with therapeutic keratoplasty (TKP). The secondary outcome measures were graft survival of the TKPs and subsequent optical keratoplasties (OKPs) and visual outcome. RESULTS:Seventy-three eyes met the inclusion criteria. A microbiological cure was achieved in 72 eyes (98.6%). Forty-one eyes (56.2%) were treated with medical therapy alone, and 32 (43.8%) eyes required 1 TKP (29 eyes) or 2 TKPs (3 eyes). Among the 32 eyes treated with TKP, 17 (53.1%) maintained a clear graft. Among 15 eyes with failed grafts, 12 eyes ultimately achieved clear grafts after a total of 19 OKP procedures. Among 41 eyes treated with medical therapy alone, all 3 eyes treated with OKP remained clear. The final median best-corrected visual acuity was 20/30 in the medical therapy group and 20/40 in the TKP group. CONCLUSIONS:A high microbiological cure rate can be achieved in eyes with fungal keratitis; however, TKP is often needed to achieve this objective. A good final visual outcome can be achieved in most cases, but multiple keratoplasty procedures may be required.