A multi-center, cross-sectional study on the burden of infectious keratitis in China.

Xiusheng Song,Yingping Deng,Zhichong Wang,Xunlun Sheng,Xiaodong Tan,Yuansheng Yuan,Yanning Yang,Jianjiang Xu,Lixin Xie,Xuguang Sun,Shaoying Fu,Qing Wang,Chen-Wei Pan

doi:10.1371/journal.pone.0113843

Abstract

ObjectiveTo understand the prevalence and demographic characteristics of infectious keratitis and infectious corneal blindness.MethodsA multi-center, population-based cross-sectional study was conducted from January 1 to August 31, 2010. A total of 191,242 individuals of all age groups from 10 geographically representative provinces were sampled using stratified, multi-stage, random and systematic sampling procedures. A majority, 168,673 (88.2%), of those sampled participated in the study. The examination protocol included a structured interview, visual acuity testing, an external eye examination, and an anterior segment examination using a slit lamp. The causes and sequelae of corneal disease were identified using uniform customized protocols. Blindness in one eye caused by infectious keratitis was defined as infectious corneal blindness.ResultsThe prevalence of past and active infectious keratitis was 0.192% (95% confidence interval [CI], 0.171–0.213%), and the prevalence of viral, bacterial, and fungal keratitis was 0.11%, 0.075%, and 0.007%, respectively. There were 138 cases of infectious corneal blindness in at least one eye in the study population (prevalence of 0.082% [95%CI, 0.068%–0.095%]). Statistical analysis suggested that ocular trauma, alcoholic consumption, low socioeconomic levels, advanced age, and poor education were risk factors for infectious corneal blindness.ConclusionsInfectious keratitis is the leading cause of corneal blindness in China. Eye care strategies should focus on the prevention and rehabilitation of infectious corneal blindness.

Highlights

The World Health Organization (WHO) reported in 2001 that corneal disease, as a major cause of blindness, ranks second only to cataracts worldwide [1]
Eye care strategies should focus on the prevention and rehabilitation of infectious corneal blindness
In recent decades, following the implementation of various programs initiated by the WHO, rates of corneal diseases attributable to Chlamydia trachomatis, onchocerciasis, and leprosy have improved

Summary

Introduction

The World Health Organization (WHO) reported in 2001 that corneal disease, as a major cause of blindness, ranks second only to cataracts worldwide [1]. In recent decades, following the implementation of various programs initiated by the WHO, rates of corneal diseases attributable to Chlamydia trachomatis, onchocerciasis, and leprosy have improved. Infectious keratitis is mainly caused by viruses, fungi, bacteria, and Acanthamoeba. Most patients with infectious keratitis have limited access to medical care. The lack of effective drugs, essential operating equipment, and well-trained medical care personnel, together with the lack of legislative guarantee and the shortage of corneal grafts, results in severe outcomes. It is estimated that trauma and corneal ulcers are responsible for 1.5–2.0 million new cases of corneal blindness every year, and this type of blindness has been recognized as a ‘‘silent epidemic’’ [2]

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Results

Conclusion