Visual impairment in fungal versus bacterial corneal ulcers four years after successful antimicrobial treatment.

Abstract

PURPOSE\nTo compare longitudinal visual acuity outcomes of fungal corneal ulcers with those of bacterial ulcers.\n\n\nDESIGN\nProspective cohort study SETTING: Tertiary eye hospital in South India STUDY POPULATION: 100 individuals who had been diagnosed four years prior with either fungal or bacterial keratitis and had been enrolled in one of two concurrent randomized trials, out of 152 consecutive participants eligible for the study.\n\n\nEXPOSURE\nCausative organism of infectious keratitis (bacteria versus fungus) MAIN OUTCOME MEASURES: Presenting visual acuity, best spectacle corrected visual acuity (BSCVA), and hard contact lens-corrected visual acuity (CLVA).\n\n\nRESULTS\nFifty study participants with prior fungal keratitis and 50 with prior bacterial keratitis were enrolled. Four years following treatment for keratitis, presenting vision in the better eye was worse than 20/60 for 12 (24.0%) individuals in the fungal group and 10 (20.0%) individuals in the bacterial group. Median BSCVA in the affected eye at the 4-year visit was similar in the fungal and bacterial groups (Snellen equivalent 20/32 for each), though vision worse than 20/400 was more common in the fungal ulcer group after spectacle correction (OR 4.19, 95%CI 1.11 to 15.8) and contact lens correction (OR 5.74, 95%CI 1.37-24.1).\n\n\nCONCLUSIONS\nIn this South Indian population with a previous episode of fungal or bacterial keratitis, correctable bilateral visual impairment was common. Although long-term visual outcomes on average were similar between fungal and bacterial ulcers, fungal ulcers were more likely to have severe visual impairment.