Abstract
ABSTRACTPurpose: Here, we report risk factors associated with outcome in severe bacterial keratitis (BK), fungal keratitis (FK), and Acanthamoeba keratitis (AK) in India.Methods: Prospective observational cohort study conducted in Aravind Eye Hospital, India. Adults presenting with severe microbial keratitis (MK) were enrolled (size ≥3 mm) and followed to 21 days post-enrolment. Ulcer clinical features were recorded at presentation. Outcomes by final visit were classified as good (completely healed or reduced infiltrate size) or poor (enlarged infiltrate size, perforated, or surgery performed).Results: Of 252 participants with severe MK, 191 had FK, 18 had AK, 19 had BK, 4 had mixed BK/FK, and 20 were microbiologically negative. Median age was 50 years (interquartile range [IQR]: 37–60 years), 64% were male, 63% were agriculturalists, and 45% had no formal education. Corneal trauma occurred in 72%, and median symptom duration before presentation was 7 days (IQR: 5–15 days). Clinical features associated with FK were feathery margins (p < 0.001), raised profile (p = 0.039), or dry surface (p = 0.007). Hypopyon was more likely in BK (p = 0.001) and ring infiltrate in AK (p < 0.001). Ulcers with poor outcome (n = 106/214) were more likely to be larger (odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.30–2.05, p < 0.001), involve the posterior cornea at presentation (OR: 2.31, 95% CI: 1.16–4.59, p = 0.017), involve Aspergillus sp. (OR: 3.23, 95% CI: 1.26–8.25, p = 0.014), or occur in females (OR: 2.04, 95% CI: 1.03–4.04, p = 0.04). Even after treatment, 34% (n = 76/221) had severe visual impairment by the final visit.Conclusions: Severe MK occurred predominantly in agriculturalists post-corneal trauma and often had poor outcomes. Provision of community-based eyecare may allow earlier treatment and improve outcomes.
Highlights
Microbial keratitis (MK) can cause significant visual impairment, blindness, or even loss of the eye, potentially having a major impact on the individual
Here, we report risk factors associated with outcome in severe bacterial keratitis (BK), fungal keratitis (FK), and Acanthamoeba keratitis (AK) in India
Among the 252 eligible participants enrolled in the study, the organisms detected were fungi in 191 (77%), Acanthamoeba sp. in (7%), bacteria in (7%), microbiologically negative in (7%), and mixed bacterial/fungal infection in 4 (2%)
Summary
Microbial keratitis (MK) can cause significant visual impairment, blindness, or even loss of the eye, potentially having a major impact on the individual. Lalitha et al studied patients with FK in South India and found that primary treatment failure (i.e., progressive worsening of the ulcer despite maximal medical treatment) or corneal perforation was associated with an infiltrate size >14 mm[2] or hypopyon at presentation or if the ulcer was culture positive for Aspergillus sp.[3] Rautaraya et al studied bacterial keratitis (BK) in East India and found that larger ulcer size (>25 mm2) or poor visual acuity at presentation was associated with poor outcome, in addition to advancing age of the patient.[4] Titiyal et al
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