Management of Filamentous Fungal Keratitis: A Pragmatic Approach

Hoffman, Jeremy J.; Arunga, Simon; Mohamed Ahmed, Abeer H. A.; Hu, Victor H.; Burton, Matthew J.

doi:10.3390/jof8101067

Open AccessReview

Management of Filamentous Fungal Keratitis: A Pragmatic Approach

by

Jeremy J. Hoffman

^1,2,*

,

Simon Arunga

^1,3,

Abeer H. A. Mohamed Ahmed

¹,

Victor H. Hu

¹

and

Matthew J. Burton

^1,4

¹

International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

²

Sagarmatha Choudhary Eye Hospital, Lahan 56500, Nepal

³

Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda

⁴

National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK

^*

Author to whom correspondence should be addressed.

J. Fungi 2022, 8(10), 1067; https://doi.org/10.3390/jof8101067

Submission received: 20 September 2022 / Revised: 3 October 2022 / Accepted: 5 October 2022 / Published: 11 October 2022

(This article belongs to the Special Issue Fungal Eye Infections)

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Abstract

Filamentous fungal infections of the cornea known as filamentous fungal keratitis (FK) are challenging to treat. Topical natamycin 5% is usually first-line treatment following the results of several landmark clinical trials. However, even when treated intensively, infections may progress to corneal perforation. Current topical antifungals are not always effective and are often unavailable. Alternatives topical therapies to natamycin include voriconazole, chlorhexidine, amphotericin B and econazole. Surgical therapy, typically in the form of therapeutic penetrating keratoplasty, may be required for severe cases or following corneal perforation. Alternative treatment strategies such as intrastromal or intracameral injections of antifungals may be used. However, there is often no clear treatment strategy and the evidence to guide therapy is often lacking. This review describes the different treatment options and their evidence and provides a pragmatic approach to the management of fungal keratitis, particularly for clinicians working in tropical, low-resource settings where fungal keratitis is most prevalent.

Keywords: microbial keratitis; fungal keratitis; management; antifungals; microbiology; natamycin; chlorhexidine

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MDPI and ACS Style

Hoffman, J.J.; Arunga, S.; Mohamed Ahmed, A.H.A.; Hu, V.H.; Burton, M.J. Management of Filamentous Fungal Keratitis: A Pragmatic Approach. J. Fungi 2022, 8, 1067. https://doi.org/10.3390/jof8101067

AMA Style

Hoffman JJ, Arunga S, Mohamed Ahmed AHA, Hu VH, Burton MJ. Management of Filamentous Fungal Keratitis: A Pragmatic Approach. Journal of Fungi. 2022; 8(10):1067. https://doi.org/10.3390/jof8101067

Chicago/Turabian Style

Hoffman, Jeremy J., Simon Arunga, Abeer H. A. Mohamed Ahmed, Victor H. Hu, and Matthew J. Burton. 2022. "Management of Filamentous Fungal Keratitis: A Pragmatic Approach" Journal of Fungi 8, no. 10: 1067. https://doi.org/10.3390/jof8101067

APA Style

Hoffman, J. J., Arunga, S., Mohamed Ahmed, A. H. A., Hu, V. H., & Burton, M. J. (2022). Management of Filamentous Fungal Keratitis: A Pragmatic Approach. Journal of Fungi, 8(10), 1067. https://doi.org/10.3390/jof8101067

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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Management of Filamentous Fungal Keratitis: A Pragmatic Approach

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