Abstract
Background/Aim: To examine the risk factors, clinical characteristics, outcomes, and prognostic factors of bacterial keratitis (BK) in Nottingham, UK.Methods: This was a retrospective study of patients who presented to the Queen's Medical Centre, Nottingham, with suspected BK during 2015–2019. Relevant data, including the demographic factors, risk factors, clinical outcomes, and potential prognostic factors, were analysed.Results: A total of 283 patients (n = 283 eyes) were included; mean age was 54.4 ± 21.0 years and 50.9% were male. Of 283 cases, 128 (45.2%) cases were culture-positive. Relevant risk factors were identified in 96.5% patients, with ocular surface diseases (47.3%), contact lens wear (35.3%) and systemic immunosuppression (18.4%) being the most common factors. Contact lens wear was most commonly associated with P. aeruginosa whereas Staphylococci spp. were most commonly implicated in non-contact lens-related BK cases (p = 0.017). At presentation, culture-positive cases were associated with older age, worse presenting corrected-distance-visual-acuity (CDVA), use of topical corticosteroids, larger epithelial defect and infiltrate, central location and hypopyon (all p < 0.01), when compared to culture-negative cases. Hospitalisation was required in 57.2% patients, with a mean length of stay of 8.0 ± 8.3 days. Surgical intervention was required in 16.3% patients. Significant complications such as threatened/actual corneal perforation (8.8%), loss of perception of light vision (3.9%), and evisceration/enucleation (1.4%) were noted. Poor visual outcome (final corrected-distance-visual-acuity of <0.6 logMAR) and delayed corneal healing (>30 days from initial presentation) were significantly affected by age >50 years, infiltrate size >3 mm, and reduced presenting vision (all p < 0.05).Conclusion: BK represents a significant ocular morbidity in the UK, with ocular surface diseases, contact lens wear, and systemic immunosuppression being the main risk factors. Older age, large infiltrate, and poor presenting vision were predictive of poor visual outcome and delayed corneal healing, highlighting the importance of prevention and early intervention for BK.
Highlights
Infectious keratitis is a major cause of corneal blindness in both developed and developing countries [1]
We observed a seasonal predilection of P. aeruginosa keratitis in summer, which has been hypothetically linked to the increased use of contact lens wear and trauma during outdoor/water activity [6], though such association remains to be elucidated
The most common risk factor was found to be corneal/ocular surface diseases (50%) and contact lens wear (32%). Another UK study conducted by our group in 2007–2010 examining the profile of sight-threatening infectious keratitis in Nottingham observed that ocular surface disease (33%), contact lens wear (26.5%), and previous ocular surgery (20.2%) were the most common risk factors
Summary
Infectious keratitis is a major cause of corneal blindness in both developed and developing countries [1]. The variations are mainly attributed to the difference in the climate of the studied region and the population-based risk factors, contact lens wear, trauma, and agricultural activities. Based on the recent literature, BK represents 90– 93% and 72–86% of all culture-proven infectious keratitis cases in the UK and in North America, respectively [4, 9,10,11,12,13]. In our recent Nottingham Infectious Keratitis Study, we observed that 92.8% of the culture-proven infectious keratitis cases were caused by bacteria, with Pseudomonas aeruginosa being the most common isolate [4]. We observed a seasonal predilection of P. aeruginosa keratitis in summer, which has been hypothetically linked to the increased use of contact lens wear and trauma during outdoor/water activity [6], though such association remains to be elucidated
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