Abstract：
OBJECTIVE: An increase in fungal and particularly filamentous keratitis has been observed in many geographic areas, mostly in contact lens wearers. This study seeks to characterize long-term trends in fungal keratitis in a continental climate area to provide guidance for diagnosis and treatment.
METHODS: Retrospective multicentric case series.
METHODS: Cases of microbiology-confirmed fungal keratitis from 2003 to 2022 presenting to tertiary care centers across Canada were included. Charts were reviewed for patient demographics, risk factors, visual acuity, and treatments undertaken.
RESULTS: A total of 138 patients were identified: 75 had yeast keratitis while 63 had filamentous keratitis. Patients with yeast keratitis had more ocular surface disease (79% vs 28%) while patients with filamentous keratitis wore more refractive contact lenses (78% vs 19%). Candida species accounted for 96% of all yeast identified, while Aspergillus (32%) and Fusarium (26%) were the most common filamentous fungi species. The mean duration of treatment was 81 ± 96 days. Patients with yeast keratitis did not have significantly improved visual acuity with medical treatment (1.8 ± 1 LogMAR to 1.9 ± 1.5 LogMAR, P = .9980), in contrast to patients with filamentous keratitis (1.4 ± 1.2 LogMAR to 1.1 ± 1.3 LogMAR, P = .0093).
CONCLUSIONS: Fungal keratitis is increasing in incidence, with contact lenses emerging as one of the leading risk factors. Significant differences in the risk factors and visual outcomes exist between yeast keratitis and filamentous keratitis which may guide diagnosis and treatment.
METHODS: Retrospective multicentric case series.
METHODS: Cases of microbiology-confirmed fungal keratitis from 2003 to 2022 presenting to tertiary care centers across Canada were included. Charts were reviewed for patient demographics, risk factors, visual acuity, and treatments undertaken.
RESULTS: A total of 138 patients were identified: 75 had yeast keratitis while 63 had filamentous keratitis. Patients with yeast keratitis had more ocular surface disease (79% vs 28%) while patients with filamentous keratitis wore more refractive contact lenses (78% vs 19%). Candida species accounted for 96% of all yeast identified, while Aspergillus (32%) and Fusarium (26%) were the most common filamentous fungi species. The mean duration of treatment was 81 ± 96 days. Patients with yeast keratitis did not have significantly improved visual acuity with medical treatment (1.8 ± 1 LogMAR to 1.9 ± 1.5 LogMAR, P = .9980), in contrast to patients with filamentous keratitis (1.4 ± 1.2 LogMAR to 1.1 ± 1.3 LogMAR, P = .0093).
CONCLUSIONS: Fungal keratitis is increasing in incidence, with contact lenses emerging as one of the leading risk factors. Significant differences in the risk factors and visual outcomes exist between yeast keratitis and filamentous keratitis which may guide diagnosis and treatment.
摘要：
目的：在许多地理区域观察到真菌性角膜炎的增加，尤其是丝状角膜炎。主要是隐形眼镜佩戴者。本研究旨在表征大陆性气候地区真菌性角膜炎的长期趋势，为诊断和治疗提供指导。
方法：回顾性多中心病例系列。
方法：纳入了2003年至2022年向加拿大三级护理中心提供的经微生物学证实的真菌性角膜炎病例。对患者的人口统计学进行了图表审查，危险因素，视敏度,和进行的治疗。
结果：共确认138例患者：75例患有酵母角膜炎，63例患有丝状角膜炎。酵母角膜炎患者的眼表疾病更多（79％vs28％），而丝状角膜炎患者佩戴的屈光性隐形眼镜更多（78％vs19％）。念珠菌种类占所有酵母鉴定的96%，曲霉菌（32％）和镰刀菌（26％）是最常见的丝状真菌。平均治疗时间为81±96天。酵母菌角膜炎患者经药物治疗后视力无明显改善(1.8±1LogMAR至1.9±1.5LogMAR,p=0.9980),与丝状角膜炎患者相反（1.4±1.2LogMAR至1.1±1.3LogMAR，p=0.0093)。
结论：真菌性角膜炎的发病率正在增加，隐形眼镜成为主要的危险因素之一。酵母菌性角膜炎和丝状角膜炎的危险因素和视觉结局存在显着差异，可指导诊断和治疗。
方法：回顾性多中心病例系列。
方法：纳入了2003年至2022年向加拿大三级护理中心提供的经微生物学证实的真菌性角膜炎病例。对患者的人口统计学进行了图表审查，危险因素，视敏度,和进行的治疗。
结果：共确认138例患者：75例患有酵母角膜炎，63例患有丝状角膜炎。酵母角膜炎患者的眼表疾病更多（79％vs28％），而丝状角膜炎患者佩戴的屈光性隐形眼镜更多（78％vs19％）。念珠菌种类占所有酵母鉴定的96%，曲霉菌（32％）和镰刀菌（26％）是最常见的丝状真菌。平均治疗时间为81±96天。酵母菌角膜炎患者经药物治疗后视力无明显改善(1.8±1LogMAR至1.9±1.5LogMAR,p=0.9980),与丝状角膜炎患者相反（1.4±1.2LogMAR至1.1±1.3LogMAR，p=0.0093)。
结论：真菌性角膜炎的发病率正在增加，隐形眼镜成为主要的危险因素之一。酵母菌性角膜炎和丝状角膜炎的危险因素和视觉结局存在显着差异，可指导诊断和治疗。
