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Microbiological Characteristics and Risk Factors Involved in Progression from Fungal Keratitis with Hypopyon to Keratitis-Related Endophthalmitis

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Abstract

Purpose

To investigate the differences in microbiological characteristics, risk factors, drug resistance, and visual outcomes in three infections: fungal keratitis with hypopyon (FKH), keratitis-related fungal endophthalmitis (FKE), and fungal endophthalmitis without keratitis (FE).

Methods

An analytical cross-sectional study.

Results

In total, 14.57% of eyes with FKH progressed to endophthalmitis. Hypopyon, pre-existence of lens problems, topical steroid use and sever keratitis were significantly associated with the development of FKE. The risk factors of the FKH and FE group were mainly plant trauma and open globe trauma, respectively. Keratitis-related endophthalmitis (FKE) showed a significantly higher resistance than the other two groups. The FKH group had the best final visual acuity, while the FKE group had the worst.

Conclusion

Hypopyon height, pre-existing lens problems, topical steroid use and sever keratitis are risk factors for progression to endophthalmitis in eyes with fungal keratitis, and its progression is not affected by a single fungus. The antifungal drugs resistance in patients with endophthalmitis related to keratitis was significantly higher than that associated with other reasons. Timely diagnosis and risk factor assessment are essential for ensuring early treatment of FKE.

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Acknowledgements

We sincerely thank Ms. Tong Liu, Eye hospital of Shandong First Medical University, and Ms. Ping Lin, Shandong Eye Institute, for their editorial and linguistic assistance.

Funding

This study was funded by National Nature Science Foundation of China (81870639 and 82070923), Taishan Scholars Program (201812150 and 20150215), the Academic Promotion Program and Innovation Project of Shandong First Medical University (2019RC009). The funding organization had no role in the design or conduct of this research.

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Author notes

  1. Yu Sun and Fanxing Zeng contributed equally to this manuscript.

Authors and Affiliations

  1. Medical College of Qingdao University, Qingdao University, Qingdao, China

    Yu Sun

  2. Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China

    Yu Sun & Fanxing Zeng

  3. Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China

    Yu Sun, Fanxing Zeng, Jingjing Zhang, Xiaolin Qi, Xiuhai Lu, Na Ning, Suxia Li, Ting Zhang, Gongqiang Yuan, Weiyun Shi & Hua Gao

  4. State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China

    Jingjing Zhang, Xiaolin Qi, Xiuhai Lu, Na Ning, Suxia Li, Ting Zhang, Gongqiang Yuan, Weiyun Shi & Hua Gao

  5. School of Ophthalmology, Shandong First Medical University, Jinan, China

    Xiaolin Qi, Weiyun Shi & Hua Gao

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  1. Yu Sun
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Correspondence to Hua Gao.

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Sun, Y., Zeng, F., Zhang, J. et al. Microbiological Characteristics and Risk Factors Involved in Progression from Fungal Keratitis with Hypopyon to Keratitis-Related Endophthalmitis. Mycopathologia 188, 805–813 (2023). https://doi.org/10.1007/s11046-023-00780-8

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