Pattern of Keratitis: A Study of 500 Cases in Tertiary Hospital of Bangladesh

Abstract

Background: Keratitis is a potentially serious corneal infection and a major cause of visual impairment worldwide. Most common form of which is infectious variety; pathogens may be bacteria, viruses, fungi and parasites which varies with age and predisposing factors. Topical antimicrobials and cycloplegic agents are the mainstay of treatment. Pattern of causative organisms and drug sensitivity changes from time to time and differs from one to another geographic location.
 Objective: To assess and evaluate the pattern of diagnosed patient of keratitis presented in a tertiary hospital.
 Material and methods: This cross-sectional study was conducted on 500 diagnosed patients of keratitis in the department of cornea of National Institute of Ophthalmology & Hospital, a well-known tertiary care hospital with 500 beds for a period of 6 months. Patients were selected based on specific selection criteria. Detail history was taken, and thorough ocular examination was done in every patient. Corneal scrapings were taken for Gram’s stain and 10% potassium hydroxide wet mount preparation. All the relevant data was recorded in a predesigned data collection sheet.
 Results: The mean age of the study subjects was 38.49 years. Male (43.2%) and female (56.8%) ratio was almost equal. The prevalence was highest among lower economic class (56.8%) as usual, and lowest among affluent class (3.8%) but not sparing them. In terms of regional distribution, majority (42.6%) of the patients came from rural area, whereas 37% from urban non-slum area and 20.8% from urban slum area. The problem was mostly observed among day-laborers (24.8%) with gradually declining trend among students (20.6%), housewives (20%), service holders (14.2%), businessmen (3.2%) and unemployed (2.2%), surprisingly! Presentation of the cases were mostly in between 2nd-3rdweek (55%), while 30% patients were presented within 1st week & 15% after 4 weeks of diagnosis. Among the cases, it was found that 28.8% patients had corneal injury, which were caused by vegetative trauma in 16% cases, 4% dust or sand trauma, 2.8% animal injury, 2.2% stick injury, 1% nail injury and 2.8% patients had history of other injury like stone, wooden materials, flying insects, dirty wire etc. Ocular diseases predispose to corneal ulcer were present in 9% patients. These were chronic dacriocistitis, entropion and trichiasis. 1.2% patients were diabetic, and 1% patients had history of inadvertent use of steroids. On the contrary, there were no specific predisposing factors in 71.2% cases. Among the cases, 96.6% experienced photophobia, 90% had foreign body sensation, 88.4% had reduced vision, 85.4% had eye pain, 78.8% suffered from watering, 73.6% had discharge, 48.8% had burning sensation, 12.2% had decreased corneal sensation and 11.2% patients noticed white spot in cornea in first stage. Slit lamp bio-microscopic examination of the patients shows 90% patients had conjunctival injection, 70% had epithelial defect, 28.6% patients had stromal infiltration, 18.4% patients had hypopyon, 14% patients had feathery pattern, 8.8% patients had suppuration, anterior chamber reaction was present in 4.4% cases and 2.2% patients had satellite lesion. The evaluation of etiology on the basis of clinical appearance reveals 61.4% of cases were presented with viral keratitis, 23.0% fungal corneal ulcer, 11.4% with bacterial corneal ulcer, 2.2% with marginal keratitis, 0.8% with exposure keratitis, 0.8% with filamentary keratitis and 0.4% cases with Acanthamoebic keratitis at the time of presentation. While assessing the depth of keratitis of the study subjects, 73.2% found superficial while 26.8% found deep. Assessment of area of corneal involvement in terms of punctate epithelial defect showed that in 46.8 % cases less than 3mm of cornea was involved, 3 to 6 mm of the cornea involved in 19.6 % cases and in 11.8 % corneal involvement was found in more than 6 mm area. Corneal scraping done in 118 (23.6%) out of 500 patients. Among them, Fungi were found in 11.2% cases, mixed organism in 4%, Bacteria in 5.6% and Acanthamoeba found in o.4% cases while 2.4% remains unidentified.
 Conclusion: Analysis of the study findings shows diversity in the pattern, presentation, predisposing factors of different form of keratitis which may be helpful as basis of further study on this problem.