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10 Cards in this Set
- Front
- Back
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Antifungal drug (5) |
Polyenes (Amphotericin B) Polyenes (Natamycin) Azoles (Ketoconazole) Azoles (Miconazole) Azoles (Fluconazole) |
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Fungal keratitis sign (3) |
1. Ring abscesses (release of lysosomal enzyme), ring infiltrate
2. Feathery appearance (in subconjunctival area)
3. Dense stromal infiltrate with indistinct margin
- risk factor: CL, topical steroid, trauma by vegetable matter, compromised immune system (esp. in yeast keratitis)
- Laboratory evaluation: smear or scraping and culture |
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Fungal keratitis (cause) (4) |
- Yeast: Candida - Mold: Aspergillus, Fusarium, Curvularia
- Corneal trauma by vegetable matter - Yeast keratitis associated with immunocompromised cornea (patient with HIV/ chemotherapy) |
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Differentiate Fungal keratitis vs acanthamoeba keratitis (3) |
Confocal Microscopy
Similar characteristic - Hypothon
Different characteristic 1. Fungal: Ring infiltrate in late stage vs Acanthamoeba: ring infiltrate then to ring absences
2. Fungal: Feathery shape infiltrate in subconjunctival area vs Acanthamoeba: no
3. Acanthamoeba disproportional pain |
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Polyenes (Natamycin) |
- effective against Fusarium - topical: 5% suspension 1 gtt q1-2h for 1-4 days, then 1 gtt 6-8 times per day - several month of therapy may be required to ensure that organism has been eliminated - standard treatment in about 12 weeks - systemic antifungal agent |
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Polyene (Amphotericin B) |
- Amphotericin B. Natamycin - topical formulation - topical: 0.15-0.3% solution 1gtt q1h |
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Azoles (Ketoconazole) |
- effective against Candida albican - topical: 1-5% suspension
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Azoles (Miconazole) |
- effective against yeast - topical: 1% suspension 1 gtt q1h |
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Azoles (Fluconazole) |
- effective against Candida and Cryptococcus - topical: 2 mg/ ml solution 1 drop q2h - oral: 100-400 mg po qd-bid |
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Treatment for fungal infection |
1. Active treatment - Started with natamycin 5% q1h for 1-4 days, then 6-8 times per day 2. Supportive treatment - epithelial debridement - cycloplegic (atropine 1% qd for 1 week) - monitor IOP from secondary glaucoma - NO TOPICAL STEROID in early stage of fungal ulcer - Cyclosporine A (Restasis) has antifungal activity If no improvement after treatment, may lead to lamellar keratoplasty (LK) or penetrating keratoplasty (PK) - need corneal transplant |
