Abstract
PURPOSE: To investigate the clinical features, antifungal susceptibility patterns, and treatment outcomes of pediatric fungal keratitis (FK) at a tertiary eye center in North China. METHODS: A retrospective study of pediatric FK cases diagnosed between July 2000 and October 2023 at Beijing Tongren Hospital, confirmed by fungal culture or microscopy. Data on demographics, predisposing factors, clinical signs, microbiological findings, treatment, and prognosis were analyzed. RESULTS: Eighty-eight pediatric FK cases (66 males, 22 females; mean age 10.8 ± 2.3 years) were collected. Trauma history (35.2%) was primarily from toys and writing tools. Dense infiltrates (100%), feathery margins (69.2%), and multifocal lesions (38.5%) were the common features. Hypopyon was less frequent (15.5%); no endothelial plaques, collar-button lesions, and pigment deposits were observed. Fusarium (43.9%) and Aspergillus (25.8%) were the predominant isolates. Amphotericin B demonstrated both in vitro and clinical efficacy. Treatment duration (median 48.1 days) varied by risk factors (P < 0.001), age (P = 0.013), and fungal type (P = 0.016). Multivariate analysis identified ocular surgery (hazard ratio [HR] = 0.04, P < 0.001) and toddler age (HR = 3.67, P = 0.013) as the strongest predictors of prolonged and faster treatment duration, respectively. CONCLUSIONS: Trauma is the leading risk factor of pediatric FK in North China, with Fusarium and Aspergillus being the predominant pathogens. Amphotericin B is the most effective antifungal, and early diagnosis and treatment are critical for improving outcomes. TRANSLATIONAL RELEVANCE: This study provides evidence-based data on fungal trends, antifungal susceptibility, and treatment outcomes, guiding optimal drug selection and therapeutic strategies to reduce visual impairment in pediatric FK.