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J Korean Ophthalmol Soc > Volume 62(7); 2021 > Article |
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Characteristic | Only culture positive (n = 89) | Only KOH positive (n = 24) | KOH and culture positive (n = 64) | Total (n = 177) | p-value* |
---|---|---|---|---|---|
Sex | 0.063 | ||||
Male | 57 (64.0) | 18 (75.0) | 32 (50.0) | 107 (60.5) | |
Female | 32 (36.0) | 6 (25.0) | 32 (50.0) | 70 (39.5) | |
Occupation | 0.065 | ||||
Agriculture | 38 (42.7) | 16 (66.7) | 36 (56.3) | 90 (50.8) | |
Non-agriculture | 51 (57.3) | 8 (33.3) | 28 (43.7) | 87 (49.2) | |
Residence | 0.392 | ||||
Urban | 33 (37.1) | 8 (33.3) | 17 (26.6) | 58 (32.8) | |
Rural | 56 (62.9) | 16 (66.7) | 47 (73.4) | 119 (67.2) | |
Systemic disease | |||||
Hypertension | 19 (21.3) | 8 (33.3) | 19 (30.0) | 46 (26.0) | |
Diabetes mellitus | 13 (14.6) | 4 (16.7) | 9 (14.1) | 6 (14.7) | |
Other† | 10 (11.2) | 2 (8.3) | 14 (21.9) | 26 (14.7) |
Causative organism | Number of fungal isolates (%) |
---|---|
Filamentous fungi | 132 (85.2) |
Nonpigmented fungi (colorless hyphae) | 85 (55.5) |
Fusarium species | 49 (31.6) |
Aspergillus species | 20 (13.5)* |
Paecilomyces species | 6 (3.9) |
Penicillium species | 5 (3.2) |
Scedosporium species | 2 (1.3) |
Beauveria species | 1 (0.6) |
Petriellidium species | 1 (0.6) |
Verticillium species | 1 (0.6) |
Pigmented fungi, dematiaceous (dark hyphae) | 30 (18.7) |
Alternaria species | 28 (17.4)* |
Colletotrichum species | 1 (0.6) |
Curvularia species | 1 (0.6) |
Mold colony (mold-like fungus) | 17 (11.0) |
Yeast | 21 (13.5) |
Candida species | 17 (11.0) |
Candida albicans | 9 (5.8) |
Candida parapsilosis | 3 (1.9) |
Candida tropicalis | 3 (1.9) |
Candida glabrata | 1 (0.6) |
Candida pelliculosa | 1 (0.6) |
Rhodotorula minuta, glutinis | 2 (1.3)† |
Cryptococcus neoformans | 1 (0.6)† |
Trichosopron beigelli | 1 (0.6) |
Other fungi | 2 (1.3) |
Plectosphaerella cucumerina | 1 (0.6) |
Corynespora cassiicola | 1 (0.6) |
Causative organism | Number of eyes* (%) |
---|---|
Filamentous fungus + Gram-positive bacteria | 29 (70.7) |
Filamentous fungus + Gram-positive bacteria + Gram-positive bacteria | 2 (4.9) |
Filamentous fungus + Gram-positive bacteria + Gram-negative bacteria | 1 (2.4) |
Filamentous fungus + Gram-negative bacteria | 2 (4.9) |
Yeast + Gram-positive bacteria | 4 (9.8) |
Yeast + Gram-positive bacteria + Gram-positive bacteria | 1 (2.4) |
Yeast + Gram-positive bacteria + Gram-negative bacteria | 1 (2.4) |
Yeast + Gram-negative bacteria | 1 (2.4) |
Fungal keratitis risk factor* | Only culture positive (n = 89) | Only KOH positive (n = 24) | KOH and culture positive (n = 64) | Total (n = 177) | p-value† |
---|---|---|---|---|---|
Ocular trauma | 43 (48.3) | 18 (75.0) | 41 (64.1) | 102 (57.6) | 0.047 |
Plant | 18 (20.2) | 10 (41.7) | 24 (37.5) | 52 (29.4) | |
Soil | 16 (18.0) | 7 (29.2) | 13 (20.3) | 36 (20.3) | |
Iron | 3 (3.4) | 1 (4.1) | 2 (3.1) | 6 (3.4) | |
Unknown | 6 (6.7) | 0 | 2 (3.1) | 8 (4.5) | |
Prior ocular surface disease | 31 (34.8)‡ | 1 (4.1) | 17 (26.6) | 49 (27.7) | 0.203 |
Herpes simplex keratitis | 9 (10.1) | 0 | 4 (4.7) | 13 (7.3) | |
Eyelid abnormalities | 8 (9.0) | 0 | 4 (6.3) | 12 (6.8) | |
Corneal opacity | 5 (5.6) | 1 (4.1) | 4 (9.4) | 10 (5.7) | |
Scleromalacia | 7 (7.9) | 0 | 3 (3.1) | 10 (5.7) | |
Bullous keratopathy | 3 (3.4) | 0 | 2 (3.1) | 5 (2.8) | |
Lacrimal duct obstruction | 2 (2.3) | 0 | 0 | 2 (1.1) | |
Previous ocular surgery | 12 (13.5) | 0 | 3 (4.7) | 15 (8.5) | 0.055 |
Topical or systemic use of steroids | 5 (5.6) | 0 | 2 (3.1) | 7 (4.0) | 0.426 |
Contact lens | 1 (1.1) | 0 | 3 (4.7) | 4 (2.3) | 0.211 |
Miscellaneous | 15 (16.9) | 5 (20.8) | 5 (7.8) | 25 (14.1) | 0.160 |
Only culture positive (n = 89) | Only KOH positive (n = 24) | KOH and culture positive (n = 64) | Total (n = 177) | p-value* | |
---|---|---|---|---|---|
Location | 0.736 | ||||
Central | 40 (44.9) | 7 (29.2) | 24 (37.5) | 71 (40.1) | |
Paracentral | 31 (34.8) | 15 (62.5) | 29 (45.3) | 75 (42.4) | |
Peripheral | 18 (20.2) | 2 (8.3) | 11 (17.2) | 31 (17.5) | |
Shape of ulcer | 0.761 | ||||
Irregular | 63 (70.8) | 11 (45.8) | 46 (71.9) | 120 (67.8) | |
Circle | 22 (24.7) | 13 (54.2) | 17 (26.6) | 52 (29.4) | |
Other | 4 (4.5) | 0 | 1 (1.6) | 5 (2.8) | |
Depth of infiltration | 0.007 | ||||
Superficial | 22 (24.7) | 16 (66.7) | 29 (45.3) | 67 (37.9) | |
Deep | 67 (75.3) | 8 (33.3) | 35 (54.7) | 110 (62.1) | |
Feathery margin | 23 (25.8) | 6 (25.0) | 25 (39.1) | 54 (30.5) | 0.093 |
Satellite lesion | 4 (4.5) | 1 (4.2) | 12 (18.8) | 17 (9.6) | 0.005 |
Hypopyon | 42 (47.2) | 3 (12.5) | 25 (39.1) | 70 (39.5) | 0.244 |
Endothelial plaque | 18 (20.2) | 3 (12.5) | 9 (14.1) | 30 (16.9) | 0.330 |
Size of ulcer (mm2) | 9.75 ± 10.67 | 3.80 ± 4.43 | 10.88 ± 11.47 | 9.35 ± 10.57 | 0.017† |
Initial VA (logMAR) | 1.54 ± 0.89 | 1.18 ± 0.85 | 1.35 ± 0.91 | 1.42 ± 0.89 | 0.164† |
Final VA (logMAR) | 1.56 ± 1.25 | 0.49 ± 0.45 | 1.03 ± 1.03 | 1.22 ± 1.16 | <0.001† |
Treatment | Only culture positive (n = 89) | Only KOH positive (n = 24) | KOH and culture positive (n = 64) | Total (n = 177) |
---|---|---|---|---|
Topical treatment* | ||||
Amphotericin B | 41 (46.1) | 22 (91.7) | 60 (93.8) | 123 (69.5) |
Fluconazole | 36 (40.4) | 22 (91.7) | 50 (78.1) | 108 (61.0) |
Voriconazole | 10 (11.2) | 1 (4.2) | 23 (35.9) | 34 (19.2) |
Natamyin | 4 (4.5) | 0 | 2 (3.1) | 6 (3.4) |
Moxifloxacin | 58 (65.2) | 22 (91.7) | 56 (87.5) | 136 (76.8) |
Fortified cefazolin | 39 (43.8) | 2 (8.3) | 2 (3.1) | 43 (24.3) |
Fortified tobramycin | 43 (48.3) | 0 | 0 | 43 (24.3) |
Ceftazidime | 11 (12.4) | 1 (4.2) | 7 (10.9) | 9 (10.7) |
Vancomycin | 12 (13.5) | 1 (4.2) | 8 (12.5) | 21 (11.9) |
Other treatment | ||||
IC antifungal injection | 12 (13.5) | 1 (4.2) | 15 (23.4) | 28 (15.8) |
SC antifungal injection | 5 (5.6) | 1 (4.2) | 16 (25.0) | 22 (12.4) |
Surgical treatment | ||||
PKP | 8 (9.0) | 1 (4.2) | 6 (9.4) | 15 (8.5) |
Evisceration | 13 (14.6) | 0 | 1 (1.6) | 14 (7.9) |
Corneal button graft | 4 (4.5) | 0 | 6 (9.4) | 10 (5.6) |
AMT | 3 (3.4) | 2 (8.3) | 3 (4.7) | 8 (4.5) |
Conjunctival flap | 2 (2.3) | 0 | 0 | 2 (1.1) |
VA | Only culture positive (n = 89) | Only KOH positive (n = 24) | KOH and culture positive (n = 64) | Total (n = 177) | p-value* |
---|---|---|---|---|---|
Improved | 36 (40.4) | 19 (79.2) | 38 (59.4) | 93 (52.5) | 0.006 |
No change | 17 (19.1) | 2 (8.3) | 12 (18.8) | 31 (17.5) | |
Aggravated | 36 (40.4) | 3 (12.5) | 14 (21.9) | 53 (29.9) |
Variable | Yeast* | Filamentous fungi† | Total | p-value‡ |
---|---|---|---|---|
Number of eyes | 20 (13.2) | 131 (86.8) | 151 (100.0) | - |
Age (years) | 70.3 ± 12.4 | 67.2 ± 11.4 | 67.6 ± 11.5 | 0.268§ |
Sex (male) | 7 (35.0) | 80 (61.1) | 87 (57.6) | 0.032 |
Risk factors for infection | ||||
Trauma | 3 (15.0) | 80 (61.1) | 83 (55.0) | <0.001 |
Ocular surface disease | 10 (50.0) | 37 (28.2) | 47 (31.1) | 0.069 |
Prior ocular surgery | 3 (15.0) | 12 (9.2) | 15 (9.9) | 0.422 |
Contact lens | 1 (5.0) | 3 (2.3) | 4 (2.6) | 0.437 |
Bacterial superinfection | 7 (35.0) | 33 (25.2) | 40 (26.5) | 0.415 |
Hypopyon | 9 (45.0) | 58 (44.3) | 67 (44.4) | 1.000 |
Deep infiltration | 15 (75.0) | 86 (65.6) | 101 (66.9) | 0.458 |
Ulcer size (mm2) | 8.53 ± 10.17 | 10.47 ± 11.18 | 10.21 ± 11.04 | 0.467§ |
Therapeutic PKP | 2 (10.0) | 14 (10.7) | 16 (10.6) | 1.000 |
Evisceration | 1 (5.0) | 12 (9.2) | 13 (8.6) | 0.699 |
Initial visual acuity (logMAR) | 1.67 ± 0.87 | 1.44 ± 0.90 | 1.47 ± 0.90 | 0.281§ |
Final visual acuity (logMAR) | 1.68 ± 1.15 | 1.30 ± 1.20 | 1.35 ± 1.20 | 0.192§ |
Initial treatment failure | 7 (35.0) | 65 (49.6) | 72 (47.7) | 0.241 |
Variable |
Univariate |
Multivariate |
||||
---|---|---|---|---|---|---|
Odds ratio | 95% CI | p-value* | Odds ratio | 95% CI | p-value* | |
Sex (male) | 0.740 | 0.404-1.354 | 0.329 | |||
Age (≥70 years) | 1.663 | 0.916-3.018 | 0.095 | 1.018 | 0.433-2.395 | 0.967 |
Rural residence | 1.548 | 0.818-2.926 | 0.179 | |||
DM | 0.668 | 0.285-1.566 | 0.353 | |||
Previous ocular disease | 7.445 | 3.397-16.318 | <0.001 | 3.744 | 1.365-10.265 | 0.010 |
Prior ocular surgery | 5.127 | 1.393-18.862 | 0.014 | 4.483 | 0.797-25.231 | 0.089 |
Contact lens use | 1.136 | 0.156-1.136 | 0.900 | |||
Satellite lesion | 0.588 | 0.207-1.557 | 0.318 | |||
Central lesion | 2.296 | 1.243-4.242 | 0.008 | 1.261 | 0.523-3.043 | 0.605 |
Deep stromal infiltration | 3.515 | 1.830-6.750 | <0.001 | 0.982 | 0.391-2.465 | 0.969 |
Ulcer size ≥5 mm2 | 3.631 | 1.950-6.761 | <0.001 | 1.596 | 0.672-3.789 | 0.290 |
Initial BCVA <0.04 (Snellen) | 4.649 | 2.465-8.767 | <0.001 | 2.639 | 0.983-7.084 | 0.054 |
Hypopyon | 5.606 | 2.894-10.860 | <0.001 | 2.941 | 1.113-7.773 | 0.030 |
Endothelial plaque | 4.764 | 1.922-11.809 | 0.001 | 2.116 | 0.596-7.512 | 0.246 |
Surgical treatment† | 33.542 | 7.735-145.453 | <0.001 | 24.482 | 4.737-126.520 | <0.001 |
Admission treatment | 2.666 | 1.306-5.444 | 0.007 | 0.525 | 0.172-1.598 | 0.256 |
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