Candida Keratitis: Epidemiology, Management, and Clinical Outcomes

Cornea. 2020 Jul;39(7):801-805. doi: 10.1097/ICO.0000000000002306.

Abstract

Purpose: To examine the epidemiological characteristics, trends, risk factors, management strategies, and clinical outcomes of Candida albicans and non-albicans keratitis over a 15-year period in a tertiary Canadian eye center.

Methods: In a retrospective observational case series of Candida keratitis from 2003 to 2017, demographics, risk factors, corrected distance visual acuity (CDVA) at initial and final consultations, medical and surgical management, and follow-up duration were recorded.

Results: Twenty-one cases of Candida keratitis were identified (62.5% of total fungal keratitis; 10 C. albicans and 11 non-albicans). The most commonly associated risk factors were topical steroid use (16 patients, 76%), ocular surface disease (15 patients, 71%), contact lens use (11 patients, 52%), and previous corneal surgery (8 patients, 38%); all patients had 2 or more combined risk factors. The number of patients with a visual acuity of 20/200 or better remained the same before and after the treatment (5/21, 24%). The mean duration of the antifungal treatment was 98 ± 126 days. Sixteen patients ultimately required surgical management (76%; 12 therapeutic keratoplasties, 3 enucleation, and 1 optical keratoplasty). When comparing C. albicans with non-albicans keratitis, we found no difference in presenting visual acuity, final visual acuity, or requirement for surgical management.

Conclusions: Candida keratitis accounts for the most identified fungal keratitis cases in this temperate climate area. An exposure to multiple risk factors appears necessary. A surgical intervention is required for the resolution of most cases. Different subspecies of Candida ultimately resulted in similar clinical outcomes.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use*
  • British Columbia / epidemiology
  • Candidiasis / diagnosis
  • Candidiasis / drug therapy
  • Candidiasis / epidemiology*
  • Cornea / microbiology*
  • Disease Management*
  • Eye Infections, Fungal / diagnosis
  • Eye Infections, Fungal / drug therapy
  • Eye Infections, Fungal / epidemiology*
  • Female
  • Humans
  • Keratitis / diagnosis
  • Keratitis / drug therapy
  • Keratitis / epidemiology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Visual Acuity*

Substances

  • Antifungal Agents