Susceptibility testing and clinical outcome in fungal keratitis

Fungal keratitis causes significant morbidity, especially in tropical climates, and is notoriously difficult to manage. The choice of antifungal agent for fungal keratitis remains largely empirical, with no consensus on the role of susceptibility testing in guiding therapy. Studies suggest that susceptibility and outcome may be associated in systemic fungal infections with some dimorphic fungi,1 but this correlation may not exist for filamentous fungi or in ocular disease because of frequent topical dosing and high drug concentration. Given the availability of new topical medications, tailoring antifungal therapy based on microbial sensitivity is important.2 Here, we assess whether fungal susceptibility testing correlates with clinical outcomes in cases of fungal keratitis. This study was a retrospective case review of consecutive patients with culture proven fungal keratitis presenting to the Aravind Eye Hospital cornea clinic between March and July 2004. Of 98 consecutive patients, minimum inhibitory concentration (MIC) data was available for 90.3 Eighty-one corresponding charts were available, and 54 charts had follow-up of at least 3 weeks to allow determination of healing. All cases were …