The impact of early keratectomy in the treatment of moderate Fusarium keratitis

Hsin-Chiung Lin

Purpose: To evaluate the safety, efficacy and cost considerations of early keratectomy in the management of moderate Fusarium keratitis.

Design: Retrospective case control study.

Participants: 112 consecutive cases of culture proven Fusarium keratitis were reviewed.

Methods: Grading of severity of keratitis was a modification of that described by Jones1; 53 cases of keratitis presented as moderate keratitis with infiltrates between 3 to 6 mm in diameter and depth of infiltration not exceeding the inner third of the cornea. A group of 10 patients with early keratectomy within one week of admission, along with a control group of 20 patients recruited over the same period, were matched for age, gender, systemic disease and severity of corneal ulcers. The main parameters evaluated were risk factors, visual acuity, adjuvant therapy, complications, hospital stay, disease duration and the cost of hospitalization.

Main Outcome Measure: The significance of the association between early keratectomy in Fusarium keratitis and visual acuity, progression to perforation, secondary glaucoma and cataract formation, adjuvant therapy, hospitalization days and cost were assessed.

Results: There were no differences between study and control groups in regard to age, sex, and systemic disease. Visual acuity and hypopyon formation were comparable on presentation. Early keratectomy patients had shorter hospital stays than controls (mean 10.5 ± 5.68 vs. 34.9 ± 18.72 days, P=0.0004). Disease duration (29.6 ± 7.41 vs. 62.05 ± 30.25 days, P=0.003) and
complication rates were significant lower in the early keratectomy group.
Median hospitalization costs per patient were lower with early keratectomy (NT$14385+ 25160 vs. 44913+7783, P<0.001; minimum NT$ 4110 vs. 17810, maximum NT$ 31510 vs. 102750) as measured by Mann-Whitney U tests, primarily because of reductions in hospital stay. Surgical fees and medication costs were comparable. Visual acuity was significantly different between
groups after treatment (P= 0.066 baseline vs. outcome P<0.001). Complication rates, especially progression to corneal perforation, were lower with early keratectomy (Chi- square= 6.4286, P=0.011) via Kaplan-Meier test. Failure with early discharge was associated with perforation, and glaucoma complications.

CONCLUSIONS: Early keratectomy in moderate Fusarium keratitis may reduce length of hospital stay, hospital costs, complications and perforation rates. Successful early discharge usually signals a benign postoperative course.

Key words: Early keratectomy; Fusarium keratitis, cost of care Financial Disclosures: The authors have no proprietary or commercial interest in any material discussed in this article.