Abstract
Purpose To analyse the clinical and microbiological characteristics and preexisting ophthalmic and systemic conditions of infectious keratitis resulting in enucleation/evisceration in a large tertiary referral center in a developed country (Hungary) over a period of 12 years. Patients and Methods. A retrospective review of enucleated/eviscerated eyes undergoing surgery between 2007 and 2018 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary, with infectious keratitis as the primary indication for enucleation or evisceration. For each subject, clinical history, B-scan ultrasound report, and microbiological analyses were reviewed. Results There were 48 enucleated/eviscerated eyes from 47 patients (29 females (61.7%), age at the time of surgery 66.4 ± 18.5 years). Indication for surgery was hopeless, unmanageable keratitis (62.5%), and keratitis with endophthalmitis (37.5%). The most common preexisting ophthalmic conditions were previous cataract surgery (60.4%), previous therapeutic penetrating keratoplasty (PKP) (56.3%), corneal perforation (52.1%), glaucoma (41.7%), and long-term topical steroid usage (31.3%). In order to treat keratitis, before enucleation or evisceration, 20 eyes (41.7%) underwent PKP, 12 eyes (25.0%) amniotic membrane transplantation, 8 eyes (16.7%) conjunctival autograft transplantation, 6 eyes (12.5%) tarsorrhaphy, and 4 eyes (8.3%) vitrectomy to salvage the eye prior to the final treatment of enucleation or evisceration. The most frequent preexisting systemic diseases were hypertension (62.5%), cardiac disease (20.8%), diabetes mellitus (20.8%), and rheumatoid arthritis (14.6%). Staphylococcus aureus (17.0%) and Propionibacterium acnes (12.8%) were the most commonly isolated gram-positive bacteria, and Pseudomonas aeruginosa was the most frequently isolated gram-negative pathogen bacterium (10.6%). Six globes (12.5%) had positive fungal cultures (1 case of Candida albicans, Candida parapsilosis, Trichosporon inkin, Acremonium sp., Fusarium sp., and Penicillium sp.). Conclusions Staphylococcus aureus, Propionibacterium acnes, and Pseudomonas aeruginosa keratitis with or without endophthalmitis represent the most common indication for ocular enucleation/evisceration in patients with microbial keratitis in a tertiary referral center in Hungary. The incidence of enucleation and evisceration related to mycotic keratitis does not seem to have increased within the last decade. Most frequent preexisting systemic diseases in cases of enucleation and evisceration are hypertension, cardiac disease, diabetes mellitus, and rheumatoid arthritis.
Highlights
Infectious keratitis is the leading cause of unilateral blindness worldwide [1]
We analysed the clinical details of microbial keratitis cases that led to severe infectious keratitis and loss of the eye at a tertiary eye care center in Hungary
Similar to Constantinou et al.’s study [5], O’Neill et al.’s [11] data from Australia, and Cruzs et al.’s [6] report from the USA, we found that Streptococci (Streptococcus pneumoniae and other Streptococci) were important grampositive causative factors of infectious keratitis that resulted in loss of the eye
Summary
Infectious keratitis is the leading cause of unilateral blindness worldwide [1]. Enucleation and evisceration are sometimes unavoidable end-stage solutions for several ophthalmic diseases. ese may be required due to infection (commonly in Asia and Africa), after severe ocular trauma, in cases of tumour or painful blind eye [2]. E primary aim of this study was to analyse current clinical and microbial indications for enucleation and evisceration in infectious keratitis at a tertiary eye care center in a European developed country (Hungary) over a period of 12 years. 2. Materials and Methods is retrospective study was undertaken at a tertiary eye care center, to analyse the current clinical and microbial indications of enucleation and evisceration in infectious keratitis in Hungary. E only case, which underwent enucleation on both eyes, was a 79-year-old female patient with severe rheumatoid arthritis. She was referred to our clinic with total corneal melting, endophthalmitis, and no light perception on the left eye in 2015 and in the right eye in 2018. Microbiological analysis was negative in case of the left eye and verified presence of S. aureus and Streptococcus pyogenes in case of the right eye
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