Background: Mycotic keratitis is an important cause of corneal blindness world over including India. Geographical\r\nlocation and climate are known to influence the profile of fungal diseases. While there are several reports on\r\nmycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The\r\nreported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and\r\nnorthern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and\r\ntreatment outcome of mycotic keratitis at a tertiary eye care center in eastern India.\r\nMethods: A retrospective review of medical and microbiology records was done for all patients with laboratory\r\nproven fungal keratitis.\r\nResults: Between July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While\r\nno organisms were found in 25.4% (253/997) corneal samples, 23.4% (233/997) were bacterial, 26.4% (264/997)\r\nwere fungal (45 cases mixed with bacteria), 1.4% (14/997) were Acanthamoeba with or without bacteria and 23.4%\r\n(233/997) were microsporidial with or without bacteria. Two hundred fifteen of 264 (81.4%, 215/264) samples grew\r\nfungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical\r\ndiagnosis of fungal keratitis was made in 186 of 264 (70.5%) cases. The microscopic detection of fungal elements\r\nwas achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%(238/251) cases. Aspergillus\r\nspecies (27.9%, 60/215) and Fusarium species (23.2%, 50/215) were the major fungal isolates. Concomitant bacterial\r\ninfection was seen in 45 (17.1%, 45/264) cases of mycotic keratitis. Clinical outcome of healed scar was achieved in\r\n94 (35.6%, 94/264) cases. Fifty two patients (19.7%, 52/264) required therapeutic PK, 9 (3.4%, 9/264) went for\r\nevisceration, 18.9% (50/264) received glue application with bandage contact lens (BCL) for impending perforation,\r\n6.1% (16/264) were unchanged and 16.3% (43/264) were lost to follow up. Poor prognosis like PK (40/52, 75.9%,\r\np < 0.001) and BCL (30/50, 60%, p < 0.001) was seen in significantly larger number of patients with late\r\npresentation (> 10 days).\r\nConclusions: The relative prevalence of mycotic keratitis in eastern India is lower than southern, western and\r\nnorth-eastern India but higher than northern India, however, Aspergillus and Fusarium are the predominant genera\r\nassociated with fungal keratitis across India. The response to medical treatment is poor in patients with late\r\npresentation.
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