진균각막염의 임상양상 및 치료실패의 위험인자에 관한 분석
Analysis of Clinical Manifestations and Risk Factors for Treatment Failure in Fungal Keratitis
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Background: Fungal keratitis is common cause of corneal infection. If not diagnosed and treated promptly and effectively, significant damage can occur. Objective: To investigate the clinical manifestations and risk factors for treatment failure in fungal keratitis. Methods: A total of 23 patients with fungal keratitis, who were diagnosed by clinical findings, smears, and cultures and followed up for at least 6 months, were studied retrospectively. Age, sex, previous history of trauma, corticosteroid use, previous ocular disease and surgery, systemic diseases, causative organism, features of keratitis, and treatment results were reviewed. A logistic regression analysis was performed to identify the prognostic risk factors. Results: Thirteen patients (57%) were male and mean age was 57 ± 18 years. Trauma with vegetable matter (30%) was most commonly noted. The causative organisms were identified in 18 eyes (78%) and Aspergillus sp. (7 eyes, 30%) was the most common detected followed by Candida sp. (6 eyes, 26%), Fusarium sp. (3 eyes, 13%) and Penicillium sp. (2 eyes, 9%). A lesion located in the central area was 13 eyes (57%) and exceeding 10 mm2 in size was 15 eyes (65%). Hypopyon was found in 7 eyes (30%). Treatment failed in 9 eyes (39%), and predictor of treatment failure was a lesion exceeding 10 mm2 (p < 0.05). Conclusions: Risk factor for treatment failure included a large lesion size. Therefore, an effort should be made to discern the clinical features of fungal keratitis and to determine appropriate early treatment for a successful treatment outcome.
Abstract
Background: Fungal keratitis is common cause of corneal infection. If not diagnosed and treated promptly and effectively, significant damage can occur. Objective: To investigate the clinical manifestations and risk factors for treatment failure in fungal keratitis. Methods: A total of 23 patients with fungal keratitis, who were diagnosed by clinical findings, smears, and cultures and followed up for at least 6 months, were studied retrospectively. Age, sex, previous history of trauma, corticosteroid use, previous ocular disease and surgery, systemic diseases, causative organism, features of keratitis, and treatment results were reviewed. A logistic regression analysis was performed to identify the prognostic risk factors. Results: Thirteen patients (57%) were male and mean age was 57 ± 18 years. Trauma with vegetable matter (30%) was most commonly noted. The causative organisms were identified in 18 eyes (78%) and Aspergillus sp. (7 eyes, 30%) was the most common detected followed by Candida sp. (6 eyes, 26%), Fusarium sp. (3 eyes, 13%) and Penicillium sp. (2 eyes, 9%). A lesion located in the central area was 13 eyes (57%) and exceeding 10 mm2 in size was 15 eyes (65%). Hypopyon was found in 7 eyes (30%). Treatment failed in 9 eyes (39%), and predictor of treatment failure was a lesion exceeding 10 mm2 (p < 0.05). Conclusions: Risk factor for treatment failure included a large lesion size. Therefore, an effort should be made to discern the clinical features of fungal keratitis and to determine appropriate early treatment for a successful treatment outcome.
참고문헌 (24)
- Thylefors B, "Global data on blindness", Bull World Health Organ, 73, pp.115~121 (1995)
- Chirambo MC, "Blindness and visual impairment in southern Malawi", Bull World Health Organ, 64, pp.567~572 (1986)
- Chirambo MC, "Cause of blindness among students in blind school institutis in a developing country", Br J Ophthalmol, 60, pp.665~668 (1976)
- Brilliant LB, "Epidemiology of blindness in Nepal", Bull World Health Organ, 63, pp.375~386 (1985)
- Gilbert CE, "Cause of childhood blindness in East Africa: results in 491pupils attending 17 schools for the blind in Malawi, Kenya and Uganda", Ophthalmic Epidemiol, 2, pp.77~84 (1995)
- Krachmer J, "Cornea and External Disease: Clinical Diagnosis and Management", pp.1011~1012 (2011), Mosby
- Kim MG, "Cornea", pp.153~154 (2013), Ilchokak
- O'Day DM, "Selection of appropriate antifungal therapy", Cornea, 6, pp.238~245 (1987)
- Thomas PA, "Fungal infections of the cornea", Eye, 17, pp.852~862 (2003)
- 박주홍, "입원 치료를 시행한 감염각막염의 분석: 미생물학적 원인, 임상 양상 및 위험 인자", 대한안과학회지, 50(8), pp.1152~1166 (2009), 대한안과학회
- Yoon KC, "Therapeutic effect of intracomeral amphotericin B injection in the treatment of fungal keratitis", Cornea, 26, pp.814~818 (2007)
- Lee KH, "Analysis of risk factors for treatment failure in fungal keratitis", J Korean Ophthalmol Soc, 42, pp.247~265 (2001)
- Srinivasan M, "al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India", Br J Ophthalmol, 81, pp.965~971 (1997)
- Laspina F, "Epidemiological characteristics of microbiological results on patients with infectious corneal ulcers: a 13-year survey in Paraguay", Graefes Arch Clin Exp Ophthalmol, 242, pp.204~209 (2004)
- 한영호, "감염성 각막염의 역학조사(II): 다병원연구", 대한안과학회지, 42(2), pp.247~265 (2001), 대한안과학회
- Kim YS, "The causative organisms and therapy of corneal ulcers", J Korean Ophthalmol Soc, 35, pp.1171~1177 (1994)
- Bhartiya P, "Fungal keratitis in Melbourne", Clin Exp Ophthalmol, 35, pp.124~130 (2007)
- Bharathi MJ, "Microbial keratitis in South India: influence of risk factors, climate, and geographical variation", Ophthalmic Epidemiol, 14, pp.61~69 (2007)
- Wong TY, "Risk factors and clinical outcomes between fungal and bacterial keratitis: a comparative study", CLAO J, 23, pp.275~281 (1997)
- Suh MK, "A clinical and mycological study of 14 cases with mycotic keratitis", Korean J Med Mycol, 3, pp.33~38 (1998)
- Saha R, "Mycological profile of infectious keratitis from Delhi", Indian J Med Res, 123, pp.159~164 (2006)
- Wong T, "Severe infective keratitis leading to hospital admission in New Zealand", Br J Ophthalmol, 87, pp.1103~1108 (2003)
- Butler TK, "Infective keratitis in older patients: a 4year review, 1998-2002", Br J Ophthalmol, 89, pp.591~596 (2005)
- Lalitha P, "Risk factors for treatment outcome in fungal keratitis", Ophthalmology, 113, pp.526~530 (2006)