Clinical profile of pythium keratitis: Perioperative measures to reduce risk of recurrence

Shweta Agarwal, Geetha Iyer, Bhaskar Srinivasan, Mamta Agarwal, Shobha Panchalam Sampath Kumar, Lily K. Therese

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

Abstract

Purpose To report the clinical profile and role of perioperative adjunctive measures to reduce the risk of recurrence in Pythium insidiosum keratitis. Methods Retrospective analysis of 10 eyes of 10 patients with P. insidiosum keratitis. Diagnosis was confirmed by PCR DNA sequencing. Results 7out of 10 patients were from urban locales, and none had any obvious history of injury with vegetative matter and were being treated for fungal keratitis. 6 eyes presented with central full thickness infiltrates with subepithelial and superficial stromal infiltrates radiating in a reticular pattern. Corneal scraping in all eyes revealed sparsely septate fungal-like filaments on potassium hydroxide/Calcofluor. All eyes underwent the first therapeutic penetrating keratoplasty (TPK) based on worsening or non-responsiveness of clinical features to the antifungal regimen. Recurrence was noted in 7 out of 10 eyes of which 2 eyes underwent evisceration. Of the six eyes that underwent cryotherapy following confirmation of microbiological diagnosis of Pythium (along with primary TPK-1, with re-TPK-5), only one eye had a recurrence and had to be eviscerated. Of the two eyes that did not undergo cryotherapy during re-TPK, following microbiological diagnosis, one eye had a recurrence and had to be eviscerated. In two eyes with adjoining scleritis, the host bed was swabbed using absolute alcohol of which one eye was salvaged. Conclusion This series highlights the need to be aware of this entity in the management of refractory fungal keratitis. It also brings to fore the adjunctive measures that could have a beneficial role in the management of pythium keratitis.

Original languageEnglish (US)
Pages (from-to)153-157
Number of pages5
JournalBritish Journal of Ophthalmology
Volume102
Issue number2
DOIs
StatePublished - Feb 2018
Externally publishedYes

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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