Management of Filamentous Fungal Keratitis: A Pragmatic Approach
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Fungi
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.
Description
Keywords
Microbial keratitis, Fungal keratitis, Management, Antifungals, Microbiology, Natamycin, Chlorhexidine
Citation
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