Early Keratectomy in the Treatment of Moderate Fusarium Keratitis

PURPOSE: To evaluate the treatment outcomes and costs of early keratectomy in the management of moderate Fusarium keratitis. METHODOLOGY/PRINCIPAL FINDINGS: Consecutive cases of culture proven Fusarium keratitis treated at our hospital between January 2004 to December 2010 were included in this retrospective study. There were 38 cases of moderate keratitis with infiltrates between 3 to 6 mm in diameter and depth of infiltration not exceeding the inner 1/3 of the cornea. After excluding 5 patients with incomplete follow-up data, 13 patients who received early keratectomy within 1 week of admission were compared with a group of 20 patients treated medically. The significance of the association between early keratectomy and visual acuity, progression to perforation, secondary glaucoma and cataract formation, adjuvant therapy, hospitalization days and cost were assessed. There were no differences between the keratectomy and medication groups in regards to age, sex, presence of systemic diseases, and hypopyon formation on presentation. The early keratectomy group had a shorter hospital stay than the medical therapy group. Disease duration was significantly lower in the early keratectomy group (median: 29.0 vs. 54.5 days, P<0.001). Median hospitalization costs per patient were lower with early keratectomy (mean ward fee: 15175.4 vs. 44159.5 NTD, P<0.001; mean donor fee: 0 vs. 900.0 NTD, P<0.001), primarily because of reductions in hospital stay. More patients in the medication group developed perforations than in the keratectomy group (20% vs. 0%, respectively) and the perforation-free rate was higher in those with early keratectomy, but the results were not statistically significant. CONCLUSIONS/SIGNIFICANCE: Early keratectomy in moderate Fusarium keratitis may reduce length of hospital stay, hospital costs, and perforation rates.