Comment on: Clinical, microbiologic, and treatment outcomes of dematiaceous fungal keratitis – A retrospective study

Dear Editor, The paper ‘Clinical, microbiologic, and treatment outcomes of dematiaceous fungal keratitis – A retrospective study’ by Ganesan et al.[1] provides a detailed analysis of the characteristics of dematiaceous fungal keratitis. After a thorough reading and understanding of their report, we have a few unanswered queries. Dematiaceous fungi are slow-growing organisms with a characteristic indolent clinical course. They tend to multiply on and colonize the corneal surface without much deeper stromal penetration. In the paper by Ganesan et al.,[1] the longest duration of symptoms before presentation was 10 days. However, 103 patients (33%) had a full-thickness involvement. An elaboration of the factors leading to this rapid involvement of the full-thickness cornea would add to the preexisting knowledge of risk factors. The use of “over-the-counter” topical steroids is a known practice. The history of using steroid eyedrops was present in 10% of the patients. We wonder what were the outcomes of this subset of patients. It would add to the existing knowledge of whether previous history of steroid eyedrops forms a risk factor for poor outcomes. The authors mention that a therapeutic debridement was performed in 15 patients with pigmented plaque. These patients had a faster healing response. Theoretically, a debridement would reduce the fungal load and facilitate the antifungal drug penetration, leading to a faster healing response. This should be applicable to both pigmented and nonpigmented plaques. It would be interesting to know if a similar response would be seen in patients with infiltrates or nonpigmented plaques. In this report, 27% of patients had a delayed healing response over 1–3 months. Factors leading to a delayed healing response would help in better prognostication and reduce the burden of a therapeutic keratoplasty on the patients and the community. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.