Response to comments on: Causative fungi and treatment outcome of Dematiaceous fungal keratitis in North India

Dear Sir,

We thank Sodhi et al.[1] for their interest and comments on our article “Causative fungi and treatment outcome of Dematiaceous fungal keratitis in North India.“[2] To answer the queries raised: the mean delay in patient presentation was 13.5 ± 14.5 days (95% confidence interval: 10.3–16.7 days; range: 1–90 days). Final visual acuity of patients with central location of ulcer was 0.96 ± 0.76 logMAR and of patients with paracentral/peripheral (combined as other group) ulcers was 0.51 ± 0.7 logMAR (P = 0.04; Independent sample t-test). In our study, the presence of hypopyon was associated with worse visual outcome [Table 1]. This univariate analysis was not presented in original article.

Table 1.

Univariate analysis of identified risk factors’ analysis for predicting visual outcome

Variable	Category	Final VA logMAR	P
Gender	Male	0.62±0.77	0.67
	Female	0.71±0.72
Age	<50 Years	0.99±0.79	0.01
	≥50 Years	0.46±0.67
Delay in presentation	≤7 Days	0.80±0.76	0.1
	>7 Days	0.45±0.69
Location of Ulcer	Central	0.96±0.76	0.04
	Paracentral/Peripheral	0.51±0.70
Size of infiltrate	≤4 mm	0.08±0.16	0.00
	>4 mm	0.93±0.76
Presence of Hypopyon	Yes	1.31±0.68	0.002
	No	0.50±0.68

Final visual acuity of the 3 patients using steroids at presentation was 20/20 in one case, 20/200 in second case. One patient was lost to follow-up. None of these patients required surgical management.

Indications for therapeutic penetrating keratoplasty were total infiltrate threatening to involve the limbus, corneal perforation of >2 mm, and infiltrate not responding to intensive medication for 1-2 weeks. Graft size used was 9 mm in two cases, 10 mm in one case, and 11 mm in one case. Postoperatively, topical antifungals, cycloplegics, and analgesics were started for 2 weeks; after that, if there was no recurrence of infiltrate, steroids were started with discontinuation of antifungal therapy. We did not use intrastromal injections or oral antifungals. We saw a good response with topical therapy in the majority of cases. Hence, we do not suggest very early surgical intervention unless indicated.

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Conflicts of interest

There are no conflicts of interest.