Predictors of outcome in fungal keratitis

Eye (Lond). 2012 Sep;26(9):1226-31. doi: 10.1038/eye.2012.99. Epub 2012 Jun 29.


Purpose: To analyse predictors of clinical outcome in fungal keratitis.

Methods: Data was collected during a prospective, randomized, controlled, double-masked clinical trial of treatment for fungal keratitis. Clinical features at presentation and demographics were collected at the enrollment visit for all patients. Pre-specified clinical outcomes included 3-month visual acuity and infiltrate/scar size, time to re-epithelialization, and corneal perforation. A separate multivariable model with each outcome as the dependent variable included all predictor variables.

Results: Predictors for worse 3-month visual acuity include older age (P=0.024), worse presentation visual acuity (P<0.001), larger infiltrate size at presentation (P<0.001), and pigmented ulcer (P=0.030). Larger infiltrate size at presentation was a significant predictor of worse 3-month infiltrate/scar size (P<0.001). Larger epithelial defect size was a significant predictor of perforation (P=0.0013). Predictors of longer time to re-epithelialization include infiltrate size at presentation (P<0.001) and older age (P=0.025).

Conclusion: Ulcer severity at presentation is highly predictive of worse outcomes. Presentation of clinical characteristics such as baseline acuity and infiltrate scar can provide important information to clinicians about prognosis, and may help guide management and treatment decisions. Prevention of corneal ulcer remains important, as it is difficult to change the course of the ulcer once it has begun.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Antifungal Agents / therapeutic use
  • Corneal Perforation / diagnosis
  • Corneal Ulcer / diagnosis*
  • Corneal Ulcer / drug therapy
  • Corneal Ulcer / microbiology
  • Debridement
  • Double-Blind Method
  • Eye Infections, Fungal / diagnosis*
  • Eye Infections, Fungal / drug therapy
  • Eye Infections, Fungal / microbiology
  • Female
  • Humans
  • Male
  • Natamycin / therapeutic use
  • Ophthalmic Solutions
  • Outcome and Process Assessment, Health Care
  • Prognosis
  • Prospective Studies
  • Pyrimidines / therapeutic use
  • Re-Epithelialization
  • Risk Factors
  • Time Factors
  • Triazoles / therapeutic use
  • Visual Acuity / physiology
  • Voriconazole


  • Antifungal Agents
  • Ophthalmic Solutions
  • Pyrimidines
  • Triazoles
  • Natamycin
  • Voriconazole