AIM: To analyze the etiological and epidemiological characteristics of fungal keratitis in the Hainan Province of China with a warm and humid tropical climate.

METHODS: Eighty-one patients(81 eyes)with fungal keratitis who attended the Corneal Services of Hainan Province Eye Hospital from January 2014 to December 2016 were retrospectively reviewed. The characteristics of fungal population, the age distributions of patients, the seasonal distribution of disease and the risk factor were analyzed. The treatment of fungal keratitis was reviewed. The positive rates of KOH based smear and fungal culture were assessed and analyzed using the Chi-squared test.

RESULTS: Eighty-one patients of fungal keratitis(including 81 eyes)were involved. The ration of the male and female was 2:1. The median age was 51 years. Corneal trauma seems to be the most common risk factor. Of all cases, 45 patients(55%)were greater than or equal to 50 years old. Twenty-eight(35%)were between 30-50 years old. Eight(10%)were less than or eaqual to 30 years old. Twenty-nine cases(36%)appeared in the first quarter indicated that fungal keratitis was most popular in the winter in Hainan Province. Standard fungal cultures were performed in 81 cases. Seventy-one of the 81 samples(88%)grew fungi. Fungal smear tests were performed in 80 cases. Forty-one cases(51%)were confirmed to be fungal keratitis by 10% KOH count. Statistical differences were found in the positive rates between fungal culture and fungal smear test(χ²=23.730, P<0.01). The predominant fungal species isolated was Fusarium sp. in 34 cases(48%)followed by asporogenous strain in 11 cases(15%). Antifungal drugs were applied in all cases. Conjunctival flap transplantation was performed in 23 cases(28%), penetrating keratoplasty in 9 cases(11%), and evisceration in 7 cases(9%).

CONCLUSION: The predominant fungal species isolated is Fusarium sp. followed by asporogenous strain. The fungal keratitis is most popular in the first quarter in Hainan Island. Corneal trauma seems to be the most common risk factor. Multidisciplinary approach, including the combined application of surgery and antifungal drugs is the treatment strategy common used for the fungal keratitis. The positive rate of fungal culture is higher than fungal smear test.