Risk factors for treatment outcome in fungal keratitis

Ophthalmology. 2006 Apr;113(4):526-30. doi: 10.1016/j.ophtha.2005.10.063.


Purpose: To identify risk factors at diagnosis that can serve as prognostic indicators of primary treatment failure in cases of fungal keratitis.

Design: Prospective, nonrandomized, interventional, comparative study.

Participants: A total of 115 consecutive patients with fungal keratitis treated at one center during a 6-month period.

Methods: Patients with a microscopic corneal ulcer smear that was positive for fungus were enrolled and treated with 5% natamycin monotherapy according to the protocol of the hospital. Treatment responses were assessed at the end of 4 weeks. The prognostic indicators were used in a Poisson model for multiple regression analysis to estimate the relative risk of the main prognostic variables.

Main outcome measures: Response of the ulcer to treatment.

Results: Of the 115 patients analyzed in the study, 52 (45.2%) were treatment successes, 27 (23.5%) had slow-healing ulcers, and 36 (31.3%) were refractory to primary treatment. Multivariate analysis showed that the predictors of treatment failure were ulcers that exceeded 14 mm(2) (P = 0.009), the presence of hypopyon (P = 0.003), and identification of Aspergillus (P = 0.003).

Conclusion: In patients with fungal keratitis treated with 5% natamycin monotherapy, larger ulcer size and infection with Aspergillus were predictors of a poor outcome.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antifungal Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Corneal Ulcer / diagnosis
  • Corneal Ulcer / drug therapy*
  • Corneal Ulcer / microbiology*
  • Eye Infections, Fungal / diagnosis
  • Eye Infections, Fungal / drug therapy*
  • Eye Infections, Fungal / microbiology
  • Female
  • Fungi / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • Mycoses / diagnosis
  • Mycoses / drug therapy*
  • Mycoses / microbiology
  • Natamycin / therapeutic use*
  • Prospective Studies
  • Risk Factors
  • Treatment Failure
  • Treatment Outcome


  • Antifungal Agents
  • Natamycin