J Korean Ophthalmol Soc > Volume 61(9); 2020 > Article |
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No. | Age/Sex | Isolates | Gram stain | KOH smear | Predisposing factor & Previous OSD & ocular surgery | Prior use of steroids | Systemic disease | Symptom duration (days) | Location & depth & size (mm2) | Hypopyon | Complete epithelialization time (days) | Surgical treatment | Initial BCVA | Final BCVA |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 71/F | CS, EC, SA | G+ cocci | - | Unknown, Excision of pterygium | - | DM | 6 | P, S, 4.9 | + | N/A* | None | HM | N/A* |
2 | 65/F | CA | - | - | Unknown, NK, BK | + | None | 3 | C, S, 6.0 | + | 39 | Conjunctival flap | HM | HM |
3 | 69/M | CS | Yeast+ | + | Soil, Cataract surgery | - | None | 20 | P, S, 6.2 | + | 21 | None | 0.02 | 0.08 |
4 | 70/F | CA | Yeast+ | + | Vegetable, CRVO, Hypertensive retinopathy | - | HTN | 15 | C, D, 25.0 | - | N/A | Evisceration | NLP | AE |
5 | 19/M | CA, SM, KP, PA | - | - | Contact lens | - | None | 3 | C, S, 4.0 | - | 10 | None | 0.01 | 1.0 |
6 | 78/M | CA | Yeast+++ | + | Soil | - | None | 60 | C, S, 4.6 | - | N/A | Enucleation | 0.08 | AE |
7 | 51/F | CA | - | + | Unknown, DES, Cataract surgery | - | TB | 7 | C, D, 3.3 | - | 8 | None | 0.5 | N/A† |
8 | 64/F | CS, Fusarium spp. | Yeast+ | + | Soil, Vegetable | - | None | 8 | C, S, 2.3 | + | N/A | Conjunctival flap, Evisceration | 0.5 | AE |
9‡ | 71/M | CA | Yeast+ | + | Vegetable | + | HTN, TIA, Angina | 60 | P, D, 4.8 | + | N/A | Evisceration | 0.1 | AE |
10 | 88/M | CA | - | - | Soil | - | HTN | 60 | P, D, 4.0 | + | 74 | AMT, Conjunctival flap | LP | LP |
11 | 74/F | Candida tropicalis, SP | G+ cocci | - | Vegetable | - | None | 7 | C, D, 5.3 | + | 17 | None | 0.01 | 0.4 |
12 | 71/F | CS | Yeast+ | + | Unknown, Exposure keratopathy | - | HTN | 14 | P, S, 3.0 | - | 14 | None | 0.1 | 0.04 |
13 | 60/F | CA | Yeast+ | + | Unknown, HSV keratouveitis, Removal of retrobulbar mass | + | DM, HTN, HBV | 60 | C, D, 4.0 | + | N/A | AMT, Scleral lamellar graft, Conjunctival flap, Evisceration | HM | AE |
14§ | 75/M | CA | Yeast+ | + | Soil DES, SPK, Blepharitis, Excision of pterygium | + | HTN, CVA | 13 | P, S, 9.0 | - | 28 | AMT #2 | 0.2 | 0.2 |
15 | 54/M | CS, Candida tropicalis, PS | - | - | Unknown, HSV keratitis, AMT for corneal perforation | + | HTN | 4 | C, D, 25.0 | - | 18 | AMT | HM | HM |
16 | 87/F | Candida famata | Yeast+ | + | Unknown, NK, HSV keratitis, Cataract surgery | + | HTN | 60 | C, D, 36.0 | - | 34 | AMT | HM | HM |
17 | 70/M | CS, Candida famata | - | - | Unknown, Pseudophakic BK, ACL implantation | + | None | 1 | C, S, 6.0 | - | 14 | AMT | 0.02 | HM |
18 | 78/M | CS, SE | - | - | Vegetable, HSV keratitis | - | Liver cirrhosis | 30 | C, S, 2.3 | - | 5 | None | HM | 0.2 |
KOH = potassium hydroxide; OSD = ocular surface disease; BCVA = best corrected visual acuity; CS = Candida species; EC = Enterobacter cloacae; SA = Staphylococcus aureus; G = Gram; DM = diabetes mellitus; P = peripheral; S = superficial; N/A = not applicable; HM = hand motion; CA = Candida albicans; NK = neurotrophic keratopathy; BK = bullous keratopathy; C = central; CRVO = central retinal vein occlusion; HTN = hypertension; D = deep; NLP = no LP; LP = light perception; AE = artificial eye; SM = Serratia marcescens; KP = Klebsiella pneumoniae; PA = Pseudomonas aeruginosa; DES = dry eye syndrome; TB = tuberculosis; TIA = transient ischemic attack; AMT = amniotic membrane transplantation; SP=Streptococcus pneumoniae; HSV = herpes simplex virus; HBV = hepatitis B virus; SPK = superficial punctate keratopathy; CVA = cardiovascular disease; PS = Pseudomonas species; ACL = anterior chamber lens; SE = Staphylococcus epidermidis.
‡ photographs of case 9 were showed in Figure 2.
§ photographs of case 14 were showed in Figure 1.
Characteristic | Total (n = 18) | CA (n = 9) | NCA (n = 9) | p-value* |
---|---|---|---|---|
Sex (male) | 9 (50) | 5 (56) | 4 (44) | 1.00 |
Age (years) | 67.5 ± 15.4 | 64.1 ± 20.0 | 70.9 ± 9.1 | 0.63† |
Age subgroup (years) | 1.00 | |||
0-19 | 1 (6) | 1 (11) | 0 | - |
20-39 | 0 | 0 | 0 | - |
40-59 | 2 (11) | 1 (11) | 1 (11) | - |
60-79 | 13 (72) | 6 (67) | 7 (78) | - |
≥80 | 2 (11) | 1 (11) | 1 (11) | - |
Symptom duration (days)‡ | 23.9 ± 24.0 | 31.2 ± 27.6 | 16.7 ± 18.6 | 0.21† |
Median (IQR) | 13.5 (5.5-60.0) | 15 (5.0-60.0) | 8 (5.0-25.0) | 0.49 |
≥14 days | 9 (50) | 5 (56) | 4 (44) | 1.00 |
Urban residency | 9 (50) | 5 (56) | 4 (44) | 1.00 |
Seasonal distribution | 0.64 | |||
Spring (Mar-May) | 4 (22) | 1 (11) | 3 (33) | - |
Summer (Jun-Aug) | 7 (39) | 4 (44) | 3 (33) | - |
Autumn (Sep-Nov) | 4 (22) | 3 (33) | 1 (11) | - |
Winter (Dec-Feb) | 3 (17) | 1 (11) | 2 (22) | - |
Gram stain result | ||||
Positive result | 11 (61) | 5 (56) | 6 (67) | 1.00 |
Yeast | 9 (50) | 5 (56) | 4 (44) | 1.00 |
Rod or cocci | 2 (11) | 0 | 2 (22) | 0.47 |
KOH smear positive | 10 (56) | 6 (67) | 4 (44) | 0.64 |
Polymicrobial infection | 7 (39) | 1 (11) | 6 (67) | 0.05 |
Predisposing factor | Total (n = 18) | CA (n = 9) | NCA (n = 9) | p-value* |
---|---|---|---|---|
Corneal trauma | 8 (44) | 4 (44) | 4 (44) | 1.00 |
Contact-lens wear | 2 (11) | 1 (11) | 1 (11) | 1.00 |
Previous OSD† | 8 (44) | 3 (33) | 5 (56) | 0.64 |
Previous ocular surgery‡ | 7 (39) | 2 (22) | 5 (56) | 0.34 |
Previous topical antibiotics use | 11 (61) | 5 (56) | 6 (67) | 1.00 |
Previous topical steroid use | 7 (39) | 4 (44) | 3 (33) | 1.00 |
Systemic disease | 11 (61) | 6 (67) | 5 (56) | 1.00 |
Hypertension | 8 (44) | 5 (56) | 3 (33) | 0.64 |
Diabetes mellitus | 2 (11) | 1 (11) | 1 (11) | 1.00 |
No apparent cause | 8 (44) | 3 (33) | 5 (56) | 0.64 |
Values are presented as number (%).
CA = Candida albicans; NCA = non-CA; OSD = ocular surface disease.
† CA group included neurotrophic keratopathy with bullous keratopathy (1 case), herpetic keratouveitis (1 case), and punctate epithelial keratitis (1 case); NCA group included herpetic keratitis (2 cases), herpetic keratitis with neurotrophic keratopathy (1 case), exposure keratopathy (1 case), and pseudophakic bullous keratopathy (1 case);
Characteristic | Total (n = 18) | CA (n = 9) | NCA (n = 9) | p-value* |
---|---|---|---|---|
Central lesion† | 12 (67) | 6 (67) | 6 (67) | 1.00 |
Infiltrate characteristic | ||||
Round infiltration | 13 (72) | 6 (67) | 7 (78) | 1.00 |
Irregular border | 4 (22) | 2 (22) | 2 (22) | 1.00 |
Satellite lesion | 1 (6) | 1 (11) | 0 | 1.00 |
Feathery like projection | 1 (6) | 0 | 1 (11) | 1.00 |
Deep infiltration‡ | 8 (44) | 5 (56) | 3 (33) | 0.64 |
Epithelial defect size (mm2) | 8.6 ± 9.6 | 7.2 ± 6.9 | 10.1 ± 12.0 | 0.54§ |
≥5 mm2 | 8 (44) | 3 (33) | 5 (56) | 0.64 |
Hypopyon | 8 (44) | 4 (44) | 4 (44) | 1.00 |
Endothelial plaque | 3 (17) | 2 (22) | 1 (11) | 1.00 |
Epithelial healing time (days)Π | 23.5 ± 18.9 | 31.8 ± 26.9 | 17.5 ± 8.8 | 0.53§ |
≥14 days | 10 (83) | 4 (80) | 6 (86) | 1.00 |
Complications | 11 (61) | 6 (67) | 5 (56) | 1.00 |
Corneal perforation | 8 (44) | 4 (44) | 4 (44) | 1.00 |
Corneal melting | 5 (28) | 3 (33) | 2 (22) | 1.00 |
Surgical treatment | 11 (61) | 7 (78) | 4 (44) | 0.34 |
AMT | 6 (33) | 3 (33) | 3 (33) | 1.00 |
Conjunctival flap | 4 (22) | 3 (33) | 1 (11) | 0.58 |
Evisceration | 5 (28) | 4 (44) | 1 (11) | 0.29 |
Presenting BCVA (logMAR) | 1.85 ± 0.91 | 1.90 ± 0.82 | 1.81 ± 1.05 | 0.93§ |
<0.1 (Snellen) | 13 (72) | 6 (67) | 7 (78) | 1.00 |
Final BCVA (logMAR)# | 2.07 ± 1.14 | 2.32 ± 1.25 | 1.81 ± 1.03 | 0.23§ |
<0.1 (Snellen) | 12 (75) | 6 (75) | 6 (75) | 1.00 |
Decreased BCVA# | 6 (38) | 3 (38) | 3 (38) | 1.00 |
Treatment outcome¶ | ||||
Success | 6 (35) | 2 (22) | 4 (50) | 0.34 |
Failure | 11 (65) | 7 (78) | 4 (50) | - |
Values are presented as mean ± standard deviation or number (%).
CA = Candida albicans; NCA = non-CA; AMT = amniotic membrane transplantation; BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution.
‡ depth of infiltration was assessed in 2 categories: superficial (more than 0% to 50%), deep (more than 50% to 100%);
Factor | Treatment success* (n = 6)† | Treatment failure (n = 11)† | p-value‡ |
---|---|---|---|
Age (years) | 60.3 ± 22.3 | 71.1 ± 10.5 | 0.19§ |
Sex (male/female) | 3/3 | 6/5 | 1.00 |
CA | 2 (33) | 7 (64) | 0.34 |
NCA | 4 (67) | 4 (36) | 0.34 |
Symptom duration (days) | 13.5 ± 10.1 | 31.3 ± 27.8 | 0.08§ |
Previous OSD | 2 (33) | 6 (55) | 0.62 |
Previous topical steroid use | 0 | 7 (64) | 0.04 |
Central location | 4 (67) | 7 (64) | 1.00 |
Epithelial defect size (mm2) | 7.2 ± 6.9 | 9.5 ± 12.3 | 0.64§ |
Hypopyon | 2 (33) | 5 (46) | 1.00 |
Polymicrobial infection | 3 (50) | 3 (27) | 0.60 |
KOH smear positive | 3 (50) | 7 (64) | 0.64 |
Gram stain: yeast positive | 2 (33) | 7 (64) | 0.34 |
Presenting BCVA (logMAR) | 1.60 ± 0.82 | 1.93 ± 0.99 | 0.50§ |
Final BCVA (logMAR) | 0.72 ± 0.55 | 2.68 ± 0.70 | <0.001§ |
Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.
CA = Candida albicans; NCA = non-CA; OSD = ocular surface disease; KOH = potassium hydroxide; BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution.