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Introduction: To analyse the fungal culture results of patients with fungal keratitis over sixteen years and look for variations in the trends over years and distribution across ages, gender and seasons. Materials and methods: Clinical and demographic records and microbiology reports of 18,898 patients of fungal keratitis from 2001 to 2016 were analysed. Results: Overall fungal culture positivity was 21.5%. 67.3% were males and 32.7% were females. Maximum numbers of samples (17.9%) were received from age group 41–50 years, and maximum fungal culture positivity was seen in age group 31–40 years (30.8%). Most common fungus was Aspergillus species (31.1%), followed by Fusarium species (24.5%), Alternaria (10.5%), Curvularia (10.2%), Helminthosporium (5.7%), Bipolaris (5.4%), Penicillium (4.5%), Candida (4.4%), Acremonium (1.2%), Rhizopus (1.0%), Paecilomyces (0.8%), Rhodotorula (0.5%) and Mucor (0.2%). Fungal culture positivity and relative frequency of fungi remained almost stable over the study duration, except Rhodotorula spp, which showed a rise 2014 onwards. Highest numbers of culture proven fungal keratitis cases were seen in monsoon season. Conclusions: To the best of our knowledge, our study is the largest compilation of epidemiological and microbiological features of fungal keratitis, throwing light on important attributes relevant to management of mycotic keratitis patients. Keywords: Keratomycosis, Fungal culture, Corneal scraping, Pathogenic fungi

Objective To compare the efficacy of topical voriconazole and topical natamycin with that of intrastromal voriconazole and topical natamycin in patients with recalcitrant fungal keratitis. Design Randomized clinical trial. Participants Forty eyes of 40 patients with fungal keratitis (positive smear or culture results or both) larger than 2 mm, involving up to two thirds of the stromal depth, and not responding to topical natamycin therapy for 2 weeks were recruited. Intervention The patients were randomized to receive either topical 1% voriconazole therapy (n = 20) or intrastromal injections of voriconazole 50 μg/0.1 ml (n = 20). The patients in both groups continued topical natamycin 5% every 4 hours until the ulcer healed. Main Outcome Measures Primary outcome measure was best spectacle-corrected visual acuity (BSCVA) 3 months after intervention, and secondary outcome measures were time to healing and the size of the scar. Results The patients in both groups had comparable baseline parameters. The mean BSCVA after treatment was 1.295±0.5 logarithm of the minimum angle of resolution (logMAR) units in the topical group and 1.692±0.29 logMAR units in the intrastromal group. The visual acuity after treatment was significantly better in the topical voriconazole group ( P = 0.008). Nineteen patients receiving topical voriconazole and 16 patients who were given intrastromal voriconazole healed with therapy. Conclusions Topical voriconazole seems to be a useful adjunct to natamycin in fungal keratitis not responding to topical natamycin. Intrastromal injections did not offer any beneficial effect over topical therapy. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

A total of 32 Staphylococcus epidermidis isolates from indwelling device-related infections such as endophthalmitis following intraocular lens (IOL) implantation, intravenous catheter-related sepsis and orthopaedic implant infections, were studied for slime production and adherence to artificial surfaces. Of these, 21 (65.6%) isolates were slime positive by the Congo Red agar method and 24 (75%) were adherent to artificial surfaces by the quantitative slime test. The majority (19 out of 24; 79.1%) of the adherent bacteria were slime producers. Antibody to slime raised in rabbits was able to inhibit the adherence of all 24 bacteria designated as adherent by our quantitative test. It seems that slime is indispensable for the sessile mode of attachment, leading further to the development of biofilms on the indwelling devices.

We report a case of a 21 year old male who presented with smear-proven fungal corneal ulcer in left eye, refractory to treatment with topical natamycin. Corneal smears and culture were taken along with anterior chamber tap for microbiological investigations and intracameral 1% voriconazole was injected followed by institution of oral as well as topical voriconazole drops. Corneal and aqueous smear as well as culture confirmed the presence of acanthamoeba. The keratitis responded favourably to voriconazole therapy which was instituted along with topical trophicidal drugs and anterior chamber became quiet by 7th day. The patient was slowly tapered from voriconazole and was off the drug by 6 months. At one year follow up, he continues to remain asymptomatic. The possibility exists that the fungal organisms had either partially or completely responded to natamycin eye drops and voriconazole therapy further inhibited their growth along with being highly efficacious in suppressing acanthamoeba trophozoites. Voriconazole may be specifically instrumental in corneal ulcers with coinfection of acanthamoeba and fungal organisms and preventing recrudescence of both. Normal saline wet mount and 10% KOH mount of paracentesis sample for suspicious cases of refractory corneal ulcers to specifically look for trophozoites in order to institute timely treatment are recommended.