New Trends on Mycotic Keratitis

Abstract

Mycotic keratitis, a severe corneal infection predominantly caused by filamentous fungi such as Fusarium, Aspergillus, and Candida, remains a major contributor to ocular morbidity worldwide. Recent trends highlight an alarming rise in cases linked to uncommon fungal species, particularly in tropical and subtropical regions, where incidence may reach 60% of microbial keratitis. Epidemiological data reveal strong associations with agricultural trauma, contact lens use, and prior corticosteroid exposure. Advances in diagnostics have shifted toward rapid, non-invasive techniques, including polymerase chain reaction (PCR), metagenomic sequencing, and in vivo confocal microscopy, which significantly improve early detection compared to traditional culture methods. Therapeutically, natamycin continues as the first-line agent, but resistance patterns and poor drug penetration necessitate innovative strategies. Emerging approaches include intrastromal and intracameral antifungal delivery, combination regimens (e.g., voriconazole with terbinafine), and adjunctive procedures such as corneal collagen cross-linking and photodynamic antimicrobial therapy. Despite these developments, surgical intervention—primarily therapeutic keratoplasty—remains essential in refractory cases, with repeat grafts often required for persistent infections. Global health concerns persist due to limited access to advanced diagnostics and antifungal agents in high-burden regions. Future directions emphasize personalized therapy guided by antifungal susceptibility testing, integration of molecular diagnostics, and cost-effective interventions to reduce vision loss. These innovations collectively aim to improve prognosis and address the unmet needs in managing this neglected tropical disease.