Liver function test changes after fungal keratitis treatment

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A study conducted by researchers from the Massachusetts Eye & Ear, Harvard Medical School, Boston, found that systemic antifungal treatment for fungal keratitis can result in elevated liver function test results. First author Lyvia J. Zhang, BA, and co-authors Reza Dana, MD, MPH, MSc, and Thomas Dohlman, MD, reported their results at the American Society of Cataract and Refractive Surgery annual meeting in Boston.¹

They pointed out that it is unknown how systemic and topical antifungal medications used to treat fungal keratitis affect liver function tests, which was the rationale for this retrospective study.

Patients of a wide range of ages were included in the study that took place from 2016 to 2022. The inclusion criteria included a diagnosis of fungal keratitis, a positive fungal corneal culture, and at least two liver function tests obtained before and during antifungal treatment. Patients who had undergone liver transplants were not included.

The medical records search identified 16 patients (9 men, 7 women) who met the inclusion criteria. The patients’ mean age at the time of diagnosis was 58.3 years.

Regarding the antifungal treatment, 12 patients received a systemic drug and the rest received only a topical formulation. The mean changes in the aspartate aminotransferase, a liver enzyme, were an increase of 29.5 ± 72.31 U/L in the group treated systemically and a decrease of 3 ± 2.45 in the group treated topically (p=0.18). The respective mean changes in the alanine transaminase values, also a liver enzyme, were an increase of +30.33 ± 103.46 U/L and a decrease of -1.5 ± 7.85 U/L (p=0.40). The respective mean changes in alkaline phosphatase were an increase of 54.58 ± 118.05 U/L and a decrease of 6.25 ± 21.98 U/L (p=0.16).

Ten patients who had been treated systemically for fungal keratitis showed an increase in at least one liver function test value, and 2 patients had liver function test values that were twice as high as the upper limit of normal.

The results showed that clinicians should be aware of the effects of systemic treatment of fungal keratitis. The authors commented, “Patients who receive systemic antifungal treatment for fungal keratitis are more likely to have elevated liver function test results than those patients receiving topical antifungal treatment.” They advised that clinicians monitor liver function in these patients.

1. Conference Abstract or Poster
   Zhang LJ, Dana R, Dohlman T. Lft changes in patients treated for fungal keratitis. Paper presented at: American Society of Cataract and Refractive Surgery 2024 annual meeting; April 5-8, 2024; Boston, Massachusetts, USA. Session: SPS-204 Corneal Infectious Disease.