Jing Zhang,1– 3 Huabo Chen,1– 3 Vishal Jhanji,4 Bining Zhang,1– 3 Lixin Xie,1– 3 Yanling Dong1– 3 

1Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People’s Republic of China; 2State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, People’s Republic of China; 3School of Ophthalmology, Shandong First Medical University, Qingdao, People’s Republic of China; 4Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

Correspondence: Lixin Xie; Yanling Dong, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong, 266071, People’s Republic of China, Email lixin_xie@hotmail.com; yanling1235@126.com

Background: Fungal keratitis is relatively rare in children. This study aimed to analyze the clinical characteristics and treatment outcomes of pediatric fungal keratitis.
Methods: A retrospective review of medical records was conducted for children (aged < 18 years) diagnosed with fungal keratitis from 1996 to 2021. Demographic features, etiology, clinical characteristics, and treatment outcomes were collected.
Results: Forty-seven children (48 eyes) were included (31 males, 16 females). The mean age of onset was 11.8± 4.1 (range: 1– 17) years. The leading cause of fungal keratitis was trauma including dust or ocular foreign body (29.2%) and vegetative matter (25.0%). Fusarium (41.7%) and Aspergillus (20.8%) were the main causative organisms. 16.7% (8/48) of the infected eyes were treated successfully with medications. Voriconazole had the highest drug sensitivity rate (70.0%). 66.7% (32/48) of the eyes required therapeutic keratoplasty (21 eyes penetrating keratoplasty, 11 eyes lamellar keratoplasty). The diameter of the corneal ulcer was significantly associated with keratoplasty (OR 3.556, p = 0.014). The peripheral blood neutrophil/lymphocyte ratio (NLR) showed positive correlation with the age of onset (r = 0.437, p = 0.002) and the diameter of corneal ulcer (r = 0.298, p = 0.04). Logistic regression analysis revealed a significant association between NLR and the need for surgical treatment (odds ratio = 117.926, p = 0.019).
Conclusion: In the current study, ocular trauma was the leading cause of fungal keratitis in the pediatric age group. Fusarium was the most common organism. Voriconazole was the preferred antifungal drug. Surgical treatment was necessary in two-thirds of the eyes.

Keywords: keratitis, fungi, children, treatment, outcomes