MODERN MANAGEMENT OF FUNGAL KERATITIS: A COMPREHENSIVE REVIEW OF DIAGNOSTICS, DRUGS, AND DILEMMAS

Abstract

Fungal keratitis is a severe and an ever-rising ocular infection that is a critical sight-threatening condition that may be found mostly in developing nations in a warm and humid climate. It usually occurs after corneal injuries with organic substance and develops very fast unless it is diagnosed and treated early enough. Fungal cornea infection is associated with less apparent and unpredictable symptoms as compared with bacterial keratitis hence distinguishing the conditions clinically is difficult. In addition, confirmation of the diseased condition at the laboratory level may take much time because of lack of resources or access to modern diagnostic equipment. This leads to poor management on an empirical basis and to poor clinical outcomes. Management of fungal keratitis is complex, as many factors contribute to adverse clinical outcomes; inherently poor corneal penetrating ability of many antifungals, the delay in diagnosis and the emergence of resistance by some fungal species being the most important. Natamycin is the treatment of choice of filamentous fungi, but is slowly being replaced by voriconazole due to increased spectrum and improved penetration into the intraocular space. These, however, do not help effectively in deep stromal infections. Non-responsive or advanced cases require the use of adjunctive treatments e.g. intracameral/intrastromal administration of antifungal fluids, and surgical procedures such as therapeutic keratoplasty. The postprocedural infection leading to graft failure still represents one of the significant clinical challenges, and the paper will offer an exhaustive overview of the available methods of the diagnostic process such as microbiological stains, culture, PCR, and in vivo confocal microscopy, as well as conduct an assessment of the current treatment alternatives in pharmacological and surgical contexts. It also brings to notice the emerging trends in antifungal treatment and drug delivery methods including nanogels and ocular inserts which promise better outcomes. Low-resource only issues such as late presentation, financial pediments, and non-qualified workers are dealt with. The study points out the necessity of early diagnosis, uniform procedures, better access of any diagnostics, and the use of new techniques to minimize the number of fungal keratitis in the world.