Surgical management of fungal keratitis

ABSTRACT

Introduction: Fungal keratitis is an important cause of corneal opacity in developing nations. The medical management poses several challenges that include nonavailability of drugs, lack of ophthalmic formulations of several potent drugs, and need for prolonged treatment. It is not uncommon to face treatment failure. Therefore, surgery plays an important role in the management of this condition. In this article, we have discussed various aspects of surgical management of fungal keratitis.

Areas covered: The manuscript is divided into three sections:

1. Limitations of medical management: The section describes challenges posed by the unique epidemiology and limitations of diagnostic procedures and available antifungal therapy.

2. Indications of surgical treatment: This section describes indications of surgical management.

3. Surgical options: This section provides an overview of different surgical options. We covered the surgical technique, limitations, and the best case scenario for the use of each option.

The discussion is based on the review of literature published in the past decade as well as experience of the authors.

Expert commentary: A variety of options are available for the management of fungal keratitis cases. Therefore, it is not impossible to salvage eyes and vision even in cases not responding to conventional medical treatment.

KEYWORDS:

• Fungal keratitis
• in-vitro susceptibility
• intracameral injection
• intracorneal injection
• surgical treatment
• deep anterior lamellar keratoplasty
• penetrating keratoplasty
• photodynamic therapy

Declaration of interest

P Garg receives funding for his research from the Department of Biotechnology, Government of India; Indian Council of Medical Research, India; and Medical Research Council, UK. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper is partly funded by the Hyderabad Eye Research Foundation, Hyderabad, India.