Ophthalmology in China ›› 2023, Vol. 32 ›› Issue (5): 416-420.doi: 10.13281/j.cnki.issn.1004-4469.2023.05.010

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Clinical features and etiological analysis of candida keratitis 

Wang Zhiqun, Deng Shijing, Zhang Yang, Liang Qingfeng, Chen Kexin, Sun Xuguang   

  1. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
  • Received:2022-12-01 Online:2023-09-25 Published:2023-09-28
  • Contact: Deng Shijing, Email: dengsj26@163.com

Abstract:  Objective To analyze the clinical and etiological characteristics of candida keratitis. Design Retrospective case series. Participants 18 patients (18 eyes) diagnosed with candida keratitis in the Beijing Tongren Hospital from January 2016 to December 2018 were enrolled. Methods Patient's medical records were reviewed. Clinical data was collected and the characteristics were observed by stages according to the severity. Corneal scraping, fungal culture or in vivo confocal microscopy was performed. Main Outcome Measures Clinical characteristics by stages, corneal scraping, fungal culture and identification of isolated strains, drug sensitivity results and result of laser confocal microscopy. Results 11 of the 18 (61.11%) patients had history of viral keratitis with long-term antiviral treatment. Of all the 11patients, 8 cases were combined with corticosteroids therapy and 3 cases were diabetes mellitus. 7/18 cases(38.89%) were in early stage with epithelial defect and multiple localized grey colonies like infiltration in epithelium and superficial stroma. 5/18 cases(27.78%) were in advanced stage with progressed infiltration and stromal ulcer, some were accompanied with hypopyon. 6/18 cases(33.33%) were in late stage, corneal ulcer enlarged and infiltration intensified, the edge of the ulcer became thinner and sulcus dissolved, often accompanied by hypopyon. 14 of the 18 patients were examined by confocal microscopy. Fungal spores were found in 13 patients and pseudohypha was found in 6 patients. Yeast-like fungi and / or pseudohyphae were detected in 11 cases (61.11%). 17 cases underwent fungal culture, 10 cases (58.82%) were Candida albicans, and 3 cases (17.64%) were Candida glabrata. The drug sensitivity of the isolated strains was more than 88.24%, and 100% to the voriconazole and amphotericin B. Conclusion Candida keratitis is more common in chronic recurrent viral keratitis patients. Clinical characteristics are aggravated colony like infiltrates and ulcer with hypopyon in severe cases. Corneal scraping, fungal culture combined with laser confocal microscopy can improve the diagnosis,and the main pathogen is Candida albicans and sensitive to voriconazole and Amphotericin B. (Ophthalmol CHN, 2023, 32: 416-420)

Key words: candida, keratitis, fungus infection