CandidaKeratitis: Epidemiology, Management, and Clinical Outcomes

Purpose: To examine the epidemiological characteristics, trends, risk factors, management strategies, and clinical outcomes ofCandida albicansand non-albicanskeratitis over a 15-year period in a tertiary Canadian eye center. Methods: In a retrospective observational case series ofCandidakeratitis from 2003 to 2017, demographics, risk factors, corrected distance visual acuity (CDVA) at initial and final consultations, medical and surgical management, and follow-up duration were recorded. Results: Twenty-one cases ofCandidakeratitis were identified (62.5% of total fungal keratitis; 10C. albicansand 11 non-albicans). The most commonly associated risk factors were topical steroid use (16 patients, 76%), ocular surface disease (15 patients, 71%), contact lens use (11 patients, 52%), and previous corneal surgery (8 patients, 38%); all patients had 2 or more combined risk factors. The number of patients with a visual acuity of 20/200 or better remained the same before and after the treatment (5/21, 24%). The mean duration of the antifungal treatment was 98 +/- 126 days. Sixteen patients ultimately required surgical management (76%; 12 therapeutic keratoplasties, 3 enucleation, and 1 optical keratoplasty). When comparingC. albicanswith non-albicanskeratitis, we found no difference in presenting visual acuity, final visual acuity, or requirement for surgical management. Conclusions: Candidakeratitis accounts for the most identified fungal keratitis cases in this temperate climate area. An exposure to multiple risk factors appears necessary. A surgical intervention is required for the resolution of most cases. Different subspecies ofCandidaultimately resulted in similar clinical outcomes.