Authors’ response to comments on clinical, microbiologic, and treatment outcomes of dematiaceous fungal keratitis – A retrospective study

Dear Editor, We appreciate the authors’ thoughtful comments on our recently published article on dematiaceous fungal keratitis. In our study, we reported an interquartile range of 3–10 days for symptom duration, representing the difference between the 75th and 25th percentiles of the data.[1] Therefore, 10 days should not be considered the longest symptom duration. The actual symptom duration among our patients ranged from 1 to 180 days, with these extremes considered outliers. Out of 103 patients (33%) with full-thickness corneal involvement,[1] 68 (66%) presented within 7 days of symptom onset, 32 (31%) between 8 and 21 days, and three (2.9%) after 22 days. Factors contributing to full-thickness ulceration within 7 days in two-thirds of these patients included diabetes in eight patients (11.7%), prior steroid or native treatment in 17 patients (25%), keratitis with a diameter >5 mm in 38 patients (55.8%), and hypopyon >1 mm in 14 patients (20.5%). This group represented 21.7% of the total 312 patients. Of the 31 patients (10%) who had used steroids before presenting to us,[1] 18 (58%) healed with topical medications, seven (22.5%) required therapeutic penetrating keratoplasty, one (3.2%) developed endophthalmitis, and five (16%) were lost to follow-up. Therefore, more than half of these patients responded well to medical treatment. Therapeutic debridement was performed in 15 patients with pigmented plaques.[1] Due to the lack of data on nonpigmented plaques, a comparison of outcomes between the two types is not feasible. Delayed healing was observed in 54 patients[1] (27.9%), including 10 diabetics (18.5%), six patients (11.1%) with lagophthalmos, eight patients (14.8%) who had been treated with steroids or native medications before presentation, and five patients (9.2%) who presented after 1 week of symptoms. In addition, 31 patients (57.4%) had keratitis with a diameter >5 mm, 19 (35.1%) had keratitis involving more than two-thirds of corneal thickness, and eight (14.8%) had hypopyon >1 mm, further emphasizing the role of keratitis severity in healing outcomes. While many subset analyses are possible within our extensive research on dematiaceous fungal keratitis, it is challenging to convey all these findings in a single article. Nonetheless, we appreciate the authors’ interest in this topic.