Corneal Ulcer Patients Research Articles

Clinical and Etiology Presentations of Keratitis Caused by Mixed Infectious Agents (Bacteria and Fungi)

Introduction: Microbiological studies following the culture of corneal infiltrates are the gold standard for determining the etiology of infectious keratitis caused by bacteria or fungi; however, even if a culture of the corneal ulcer is obtained. Purpose: To investigate the predisposing factors and clinical and Etiology presentations of keratitis caused by mixed infectious agents (bacteria and fungi). Methods: This was a prospective study of cases with mixed bacterial and fungal keratitis, done between July to December 2022 in Department of Ophthalmology, Netraloy Eye Care Center, Thanthania, Bogura Sadar, Bogura, Bangladesh. Sixty (60) cases of mixed bacterial and fungal keratitis were identified. Samples (corneal swabs and scrapings) were collected aseptically from corneal ulcer patients. Isolation and identification of the microbial agents and antimicrobial susceptibility testing were done in the Microbiology and Pathology departments. Results: 38 cases (63.3%) were men, and the mean age was 54.2±9.3 years. The affected people were mostly (50; 83.3%) residing in the rural areas. 34 patients (56.7%) were involved in agricultural activities. The people of 41- 60 years of age were particularly prone to this disease (40; 66.7%). The most common predisposing factor for mixed keratitis was a history of ocular trauma (42; 70%) and 28 patients (46.7%) had a history of trauma with vegetative matter. The incidence of the disease was highest in the monsoon season, between June to September (32; 53.3%). The most common causative bacterial organisms was Staphylococcus aureus (26;43.3%) followed by Pseudomonas secies (10;16.7%) and among fungal organisms was Aspervgillus fumigates (22;36.7%) followed by Fusarium species (12;20%). Conclusion: The identification of the etiology and the predisposing factors of corneal ulcers in this region are important for the prevention and early treatment of the disease. Usually, patients with mixed bacterial and fungal keratitis have poor prognosis. Thus, when the infectious keratitis is running an atypical course or found unresponsive to the initial medical treatment, the possibility of a mixed infection by bacterial and fungal organisms should be considered.

Establishment of a corneal ulcer prognostic model based on machine learning

Corneal infection is a major public health concern worldwide and the most common cause of unilateral corneal blindness. Toxic effects of different microorganisms, such as bacteria and fungi, worsen keratitis leading to corneal perforation even with optimal drug treatment. The cornea forms the main refractive surface of the eye. Diseases affecting the cornea can cause severe visual impairment. Therefore, it is crucial to analyze the risk of corneal perforation and visual impairment in corneal ulcer patients for making early treatment strategies. The modeling of a fully automated prognostic model system was performed in two parts. In the first part, the dataset contained 4973 slit lamp images of corneal ulcer patients in three centers. A deep learning model was developed and tested for segmenting and classifying five lesions (corneal ulcer, corneal scar, hypopyon, corneal descementocele, and corneal neovascularization) in the eyes of corneal ulcer patients. Further, hierarchical quantification was carried out based on policy rules. In the second part, the dataset included clinical data (name, gender, age, best corrected visual acuity, and type of corneal ulcer) of 240 patients with corneal ulcers and respective 1010 slit lamp images under two light sources (natural light and cobalt blue light). The slit lamp images were then quantified hierarchically according to the policy rules developed in the first part of the modeling. Combining the above clinical data, the features were used to build the final prognostic model system for corneal ulcer perforation outcome and visual impairment using machine learning algorithms such as XGBoost, LightGBM. The ROC curve area (AUC value) evaluated the model’s performance. For segmentation of the five lesions, the accuracy rates of hypopyon, descemetocele, corneal ulcer under blue light, and corneal neovascularization were 96.86, 91.64, 90.51, and 93.97, respectively. For the corneal scar lesion classification, the accuracy rate of the final model was 69.76. The XGBoost model performed the best in predicting the 1-month prognosis of patients, with an AUC of 0.81 (95% CI 0.63–1.00) for ulcer perforation and an AUC of 0.77 (95% CI 0.63–0.91) for visual impairment. In predicting the 3-month prognosis of patients, the XGBoost model received the best AUC of 0.97 (95% CI 0.92–1.00) for ulcer perforation, while the LightGBM model achieved the best performance with an AUC of 0.98 (95% CI 0.94–1.00) for visual impairment.

Characteristics of Corneal Ulcer Patients at Bali Mandara Eye Hospital in 2021-2022

Background: A corneal ulcer is a pathological discontinuity of corneal epithelium surface. The incidence in developing countries reached 1.5-2 million per year and one of the causes of blindness. Corneal ulcers can occur at any age and gender which is influenced by geographic conditions. The causes of corneal ulcers vary depend on the region, predisposing factors, and microorganisms in the particular community. Purpose: To know the characteristics of corneal ulcers particularly at the Bali Mandara Eye Hospital and as a basic data for further research. Methods: A total of 77 selected medical records at Bali Mandara Hospital from January 2021–May 2022 were used in this descriptive study using a retrospective method. Patient characteristics, etiology, clinical characteristics, management, and complications were identified in this study. Descriptive analysis was performed on all data and presented in frequency tabulation. Results: In this study, 52 cases (67.5%) were male and 25 cases (32.5%) were female. The largest age group was 24-64 years with 34 cases (44.2%). All cases with corneal ulcers (100%) complained of red eye symptoms. Trauma (61.0%) as the most common predisposing factors that was caused by plants (24.7%). The most common etiologies were bacteria (46.8%) followed by fungi (5.2%), and mixed (28.6%). Most of the cases were managed without treatment (66.2%) with the outcome of improvement (55.8%), without complications (53.2%), perforation (28.6%), and descemetocele (15.6%). Conclusion: Most patients with corneal ulcers at the Bali Mandara Eye Hospital are male than female with range of 24-64 years and trauma being the most common predisposing factor. This is because it is the range for productive age and the majority of the population in Indonesia, especially Bali, works as farmers. Most microorganisms that cause corneal ulcers are bacteria. Most patients receive non-surgical treatment with more than 50% of patients experiencing improvements in vision and no complications. Keywords: Corneal Ulcers, keratitis, ocular trauma, visual impairment

STUDY OF CLINICAL PROFILE AND RISK FACTORS OF INFECTED CORNEAL ULCERS AT RURAL TERTIARY CARE HOSPITAL

Introduction: A corneal ulcer is a discontinuation in normal epithelial surface of cornea associated with necrosis of the surrounding corneal tissue. It is a major worldwide cause of preventable corneal blindness that is mostly under-reported but can be responsible every year for 1.5–2.0 million new cases of monocular blindness. Detailed studies of severe sight-threatening infectious keratitis are therefore important as they provide valuable information on the detection of etiology, predisposing factors, and visual outcomes to form the development of management strategies and protocols. Aims and Objectives: To study the clinical profile and known risk factors of infected corneal ulcers at rural tertiary care hospital. Materials and Methods: An Observational, Descriptive Cross-Sectional Hospital-based study was conducted after Institutional Ethical Committee (IEC) at the Department of Ophthalmology, DVPRMC, Loni. A total of 70 patients with infected corneal ulcers were screened and evaluated from June 2022 to May 2023 for a duration of 1 year. We studied the infected corneal ulcer patients above 18 years old attending to our hospital OPD. Results: 57% of patients were male and 43% were female. 66% of patients gave a history of trauma. The most common clinically diagnosed ulcer was fungal, representing 53% of all ulcers, followed by bacterial (27%) and viral (13%). There were also 2 cases each of acanthamoeba (3%) and pythium (3%) ulcers. 62.8% of cases were above 50 years old. In our study 73% of suspected fungal corneal ulcers were KOH smear-positive and 70% of suspected bacterial corneal ulcers were gram-positive. All cases were advised medical management. Out of those 43% were also advised therapeutic penetrating keratoplasty. Conclusion: Corneal ulcers are commonly seen in adult male farmers and laborers with ocular trauma in rural areas and fungal ulcer is the most common type of ulcer. Late presentation with corneal perforation requires therapeutic penetrating keratoplasty.

A New Treatment for Recalcitrant Neurotrophic Keratopathy of Ocular Graft-Versus-Host Disease with Virus Infection.

Neurotrophic keratopathy (NK) is a rare degenerative ocular disease that can be difficult to treat. There were no effective resolutive treatments for severe NK caused by ocular graft-versus-host disease (oGVHD) along with virus infection. To address this question, we designed a prospective cohort study to evaluate the efficacy and safety of topical recombinant human nerve growth factor (rhNGF) in patients with recalcitrant NK of oGVHD and viral infection. This prospective cohort study enrolled patients with recalcitrant NK diagnosed with oGVHD and treated with rhNGF. Clinical evaluations included the range of epithelial defects, best corrected visual acuity, intraocular pressure, slit-lamp examination, and corneal fluorescein staining. Examinations of the central corneal thickness, corneal sensitivity, and nerve fiber regeneration were performed at each visit at 4, 8, 12, 20weeks and 6months, respectively, after initiating rhNGF treatment. All enrolled patients were diagnosed with NK at stage2 (7 eyes, 63.6%) or stage3 (4 eyes, 36.4%) and responded to rhNGF treatment. Five of 11 (45.5%) and 9 of 11 eyes (81.8%) achieved complete corneal epithelial healing after 4 and 8weeks, respectively. All 11 eyes (100%) achieved complete corneal healing after 12weeks. There was also a significant reduction in the corneal ulcer area during each visit (P < 0.001), as well as in the corneal fluorescein staining score (P < 0.010). There was a significant improvement in corneal sensation when compared to the baseline (P < 0.050). Topical treatment with rhNGF effectively promoted the complete corneal healing of persistent epithelial defects and corneal ulcers in patients with recalcitrant NK in oGVHD and viral infection.

Demographic and microbiological profile of corneal ulcer patients presenting at a tertiary healthcare center of Eastern India during the COVID era: A hospital-based cross-sectional study.

To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.

Tactics of Managing Patients with Bacterial Corneal Ulcers in a Multidisciplinary Hospital (Series of Clinical Cases)

Bacterial corneal ulcers in patients with comorbid pathology are a complex clinical situation with a high risk of complications — corneal perforation. The article presents four clinical cases of bacterial corneal ulcers in patients with chronic latent sinusitis. The publication discusses the issues of diagnostic tactics, provides an analysis of the results of instrumental and laboratory tests in each case. The results of corneal ulcer therapy are presented taking into account antibioticograms.

Clinical profile of corneal ulcers at a tertiary care hospital, North-West Rajasthan, India

Background Corneal ulcer is an inflammatory or more seriously infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma. Aim The aim of this study was to evaluate the clinical profile of corneal ulcers at Sardar Patel Medical College and associated group of hospitals, Bikaner, Rajasthan, India. Patients and methods This is a prospective, longitudinal, observational study that was conducted for two years from October 2020 to October 2022. It involved 100 clinically diagnosed corneal ulcer patients, recruited by consecutive sampling, attending the Outpatient Clinic at the Department of Ophthalmology, who were willing to participate in the study. Clinical evaluation included the sociodemographic aspects and the ulcer characteristics, including its location, shape, depth, presence of satellites, and hypopyon. Corneal scraping was performed in 60 cases with full aseptic measures after the instillation of topical anesthetic and the samples were sent to the Microbiology Department for further processing. Results The maximum proportion (52%) of the study population were 41-60 years old, with 58% of the patients being males, and 75% from rural areas. Most of the ulcers (68%) were central or paracentral in location, with 38% being of ameboid shape and 48% being superficial. Based on etiology, 48% were fungal, 32% were bacterial, 16% viral, 1% parasitic, and 3% noninfective. The most common pathogen was Aspergillus fumigatus followed by Staphylococci and viral infection. Conclusion Corneal ulcers were found most commonly in males aged 40–60 years hailing from rural areas engaged in agriculture. The most common etiological agent was Aspergillus fumigatus followed by Staphylococci.

Clinical Profile of the Patients of Fungal Corneal Ulcer: A Hospital Based Study

Clinical Profile of the Patients of Fungal Corneal Ulcer: A Hospital Based Study

Clinical Grading of Corneal Ulcer and Its Management in Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Infectious corneal ulcer (CU) occurs due to an agent, which may be a bacterial, fungal, or viral microorganism. A detailed examination of the ulcer was needed to determine the severity grading of the ulcer. Based on the size, depth of ulcer, density of infiltrate, and scleral involvement, it's divided into mild, moderate, and severe grades and may be used to objectively monitor the progress of the ulcer and as a parameter for management. Medical management includes topical, systemic antibiotic, and periocular injection, while amniotic membrane transplantation (AMT), conjunctiva flap, fascia lata, and evisceration as surgical. This study aimed to assess the clinical grading associated with the management of CU in Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: Observational analytics based on the medical record of corneal ulcer patients in Dr. M. Djamil General Hospital, Padang, Indonesia, in 2016-2017. A total of 191 research subjects participated in this study. Data analysis was carried out using SPSS univariately.&#x0D; Results: The fungal, bacterial, and viral CU was diagnosed clinically. The severity grading that we found is moderate (60,73%), mild (25,14%), and severe (14,13%). All of the cases used medical treatment. Surgical was performed in moderate (36,59%) and all severe cases. AMT was performed in severe cases with perforation ≤ 4 mm and perforation &gt; 4 mm conjunctival flap (3.7%), fascia lata (3,7%), and evisceration (61,53%), preferably.&#x0D; Conclusion: The clinical grading of corneal ulcers in our hospital is moderate, and it may be associated with our hospital as a referral hospital. Surgery was performed in all severe and moderate cases that don't respond well to medicine.

ROLE OF TOPICAL INSULIN EYE DROP AND ITS COMPARISON WITH PACK-CXL IN CASE OF NON HEALING CORNEAL ULCER

Present study evaluates efcacy of topical insulin eye drops and PACK-CXL in treatment of non-healing corneal ulcer. For this total 20 patients of corneal ulcer were taken and categorise as two groups, Group-1 and Group-2. Patients of Group-1 were treated with topical insulin eye drop, while 2 Group-2 with PACK-CXL. In result, mean area of ulcer before starting treatment in Group-1 was 25.45 ± 16.5 mm and we observed complete corneal reepithelization in all patients, with mean duration of reepithelization seen in 35 days. In group-2 mean area of non-healing ulcer before 2 starting treatment was 20.58±10.63 mm , after PACK-CXL, we observed complete corneal reepithelization in all patients with, mean duration of 25.4 days. Final visual acuity was improved from baseline in both groups. Both topical Insulin eye drop and PACK-CXL can promote and accelerate corneal reepithelization of non-healing corneal ulcers but topical insulin eye drop is cost-effective with no adverse effect

Clinical observation of recombinant human nerve growth factor in the treatment of neurotrophic keratitis.

To characterize changes of corneal nerve morphology and tear indices in patients with neurotrophic keratitis (NK) treated with recombinant human nerve growth factor (rhNGF). In a prospective observational study, six patients (nine eyes) were locally treated with rhNGF. Visual acuity, corneal fluorescein staining score, the heights of the tear river, lipid layer thickness (LLT), tear ferning (TF) test, conjunctival impression cytology (CIC) examination, the densities of cornea subbasal nerve fibers were determined before and after treatment. Compared with baseline, there was a significant difference in corneal fluorescence staining scores (P<0.01); all patient corneal epithelial defects recovered completely within 8wk, but there was no significant improvement in the height of the tear river (P=0.202). LLT was significantly increased when compared with baseline (P=0.042); however, the function of conjunctival goblet cells and mucin content did not significantly improve using the TF test and CIC examination (P=0.557, P=0.539). After 8wk of treatment, the average corneal subbasal nerve fiber density increased significantly (P<0.01), as did the number of corneal nerve fiber branches (P=0.001). RhNGF can increase the density of corneal subbasal nerve fibers, promote the healing of persistent corneal epithelial defects and corneal ulcers in patients with NK, also improving tear function partially.

Clinical Approach to Corneal Ulcers

A corneal ulcer is a break or defect in the surface epithelium of the cornea, accompanied by tissue decay in the nearby area, leading to stromal necrosis. On a pathological level, there are swelling and an influx of cells in the affected region. Corneal ulcers often arise due to bacterial, viral, fungal or parasitic infections. However, non-infectious causes, such as dry eye, inflammatory disorders and trauma, also have a role. Delayed treatment can lead to blindness. Accurate diagnosis and prompt management are essential. Initially, patient history provides clues. A history of contact lens wear is often linked to bacterial or Acanthamoeba infections. Scratches may herald fungal infections, especially in agricultural settings. Viral aetiologies often correlate with dendritic patterns. Next, the slit-lamp examination can highlight corneal defects and infiltrates. Fluorescein staining may enhance the visibility of epithelial defects. Diagnostic procedures may include corneal scraping for microscopy, culture or polymerase chain reaction (PCR). This aids in identifying causative agents and tailoring antimicrobial therapy. Empirical treatment, especially in severe or progressing ulcers, begins before culture results. Bacterial ulcers frequently receive broad-spectrum antibiotics initially. Fungal infections warrant antifungal therapy, often with natamycin. Acanthamoeba keratitis necessitates specific antiamoebic therapy. Refractory or complex cases might demand additional interventions, such as corneal cross-linking or therapeutic keratoplasty. Appropriate patient education, such as contact lens hygiene, can serve as a preventative measure. Overall, understanding the underpinnings and a systematic approach to diagnosis and management are vital in preserving vision and avoiding complications in corneal ulcer patients.

Autologous platelet-rich plasma eye drop for moderate-to-severe bacterial corneal ulcers: Changes in interleukin-6 tear concentration and clinical outcomes.

The objective of this study was to evaluate interleukin-6 (IL-6) tear concentration and clinical outcome in patients with moderate-to-severe bacterial corneal ulcers post autologous platelet-rich plasma (PRP) eye drop therapy. This was a pre-post designed study involving 21 moderate-severe corneal ulcer patients who got autologous PRP eye drop. Subjects were got autologous PRP eye drop as adjuvant therapy. Patients with moderate-to-severe infectious bacterial corneal ulcers were included in this study. Tear sampling was performed before therapy using sterile Schirmer paper from conjunctival inferior fornix. PRP therapy was performed for 7 days. Data recording and tear sampling were then performed at day 0 (pre-PRP), day 7 (D+7), and day 14 (D+14) after PRP therapy. Data recording included presence of pericorneal injection, blepharospasm, size of corneal defects, and hypopyon. There was a decrease in IL-6 tear concentration by day 14 after PRP therapy (P < 0.001). IL-6 concentration at day 7 after therapy (7525.67 ± 7092 pg/mL) tended to be lower before therapy (10,599 ± 6158 pg/mL), but not statistically significant (P = 0.156). The size of corneal defects decreased significantly post PRP at day 7 (P = 0.035) and at day 14 (P = 0.001). There was a significant blepharospasm at day 7 (P = 0.012) and day 14 (P < 0.001). There was a significant pericorneal injection only at day 14 (P = 0.002). There was no significant decreased hypopyon. There was a significant reduction in IL-6 tear concentration and clinical improvement in moderate-to-severe bacterial corneal ulcers which got autologous PRP eye drop as adjuvant therapy.

The prevention and therapy of corneal ulcers in patients with large-area thermal burns

Objective: To evaluate the characteristics of ocular injury in patients with severe extensive thermal burns, and to explore the effective methods to prevent and treat corneal ulcers related to severe burns. Methods: A retrospective case series study. Between 2010 and 2019, Sixteen severe thermal burn patients with burn sizes>70% of the total body surface area involving the ocular region were admitted to the Burns and Plastic Surgery Division of Chinese PLA General Hospital, and consult with Ophthalmology Division. There were deep second-degree to fourth-degree burns in the eyelids. In the eleven surviving patients, 22 eyes presented ectropion. Eyelid full-thickness skin grafting (EFTSG) combined with or without tarsorrhaphy was performed in 20 eyes due to severe corneal exposure. Two eyes received partial blepharorrhaphy because of mild ectropion. The ocular manifestations and treatment outcomes were reviewed and assessed. Results: The majority of the patients were youth, and the average age was (36.8±10.4) years. The burn area was 84.0%±9.1% of the body surface area. Corneal ulcers secondary to lagophthalmos occurred at (35.1±15.6) days after burning in 75% (24/32) of eyes. Perforation was found in 18.8% (6/32) of eyes. Among the 22 operated eyes, the corneal ulcer was repaired in all 9 eyes receiving EFTSG with tarsorrhaphy, whereas ectropion recurred in 8 of 11 eyes only receiving EFTSG, and 4 eyes underwent further surgery due to corneal epithelial defects. Conclusions: In patients with severe large-area thermal burns, corneal ulcers are common complications. Prevention of corneal exposure is vital because the treatment of corneal ulceration is difficult due to eyelid deformity, inflammation and the absence of donor skin. Timely full-thickness skin grafting and blepharorrhaphy are effective approaches to preventing exposure keratopathy. To severe ulcers occur, conjunctival flap or Tenon's capsule covering combined with eyelid EFTSG and tarsorrhaphy is useful to rescue visual function.

Microbiological Profile of Corneal Ulcer in Dr. Mohammad Hoesin General Hospital Palembang, Indonesia: July to September 2021

Introduction: Microbial agents cause infectious processes, which may result in corneal inflammation leading to corneal necrosis, ulceration, and perforation. This disorder is one of the major etiologies of monocular blindness in developing countries in Asia, Africa, and the Middle East. The etiology of corneal ulcers varies in different regions.&#x0D; Methods: This research is a descriptive study approach. Data obtained from the medical records of patients who were registered as corneal ulcer patients in Dr. Mohammad Hoesin Palembang from July 2021 to September 2021.&#x0D; Results: A total of 9 patients were diagnosed with a corneal ulcer. The number of corneal ulcer patients was more in male patients (77.8%). The age of patients varies from 16 years to 63 years, and most elderly patients are diagnosed with this condition. Predisposing factors are unknown in most patients. The most common location for ulcers is the central cornea (88.9%), with &gt;6 mm in size. Hypopyon is found in 2 patients (22.2%), while perforation and corneal melting in 1 patient consecutively. The most common microbiological profiles of corneal ulcer patients in this study are unspecified (66.7%), while ulcers due to bacteria in the second place of the microbiological profile (33.3%) consist of Enterobacter aerogenes, Staphylococcus epidermidis, and Pantoea spp and sensitive to almost all kinds of antibiotics.&#x0D; Conclusion: The most common microbiological profiles of corneal ulcer patients in this study are unspecified, while ulcer due to bacteria in the second place of the microbiological profile consists of Enterobacter aerogenes, Staphylococcus epidermidis, and Pantoea spp and sensitive to almost all kinds of antibiotics.

Traditional eye medicine associated keratitis- Current trends and practices

To study the prevalence, types and demographic profile of traditional eye medicine (TEM) use among corneal ulcer patients presenting to a tertiary eye care centre in South India.A cross-sectional study conducted on 432 new corneal ulcer patients at a tertiary eye care centre in South India from September 2018 to July 2019. Data collected included demographic profile such as name, age, sex, occupation, income, rural/urban residence, type of TEM use. Of the 432 new corneal ulcer cases, 32 used TEM. Most TEM users belonged to the age group 40- 60 years (n= 20; 62.5%). There was no difference in sex distribution. Majority of TEM users in our study resided in rural areas (n= 30; 93.75%), were involved in agriculture as occupation (n=28, 87.5%) and belonged to the lower socioeconomic status n=31(96.88%) as per Kuppuswamy classification. Profile of TEM used ranged from plant extract (n= 14; 43.75%), tongue cleaning (n= 5; 15.63%), oil (n= 7; 21.87%), breast milk (n= 4; 12.5%) and ash (n= 2; 6.25%). Use of traditional medicine is a prevalent practice in the study population. These findings offer a better understanding of health seeking behaviour of the study population which will lead to better planning, implementation and targeting of preventive and promotive eye services and awareness programmes.

Risk factors, causative organisms and sensitivity patterns of infective keratitis in a tertiary care hospital in Rawalpindi.

To determine the risk factors, causative organisms, sensitivity patterns and treatment outcomes of infective corneal ulcers. The prospective cohort study was conducted from January 2018 to December 2019 at the Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan, and comprised eyes of patients with corneal ulcer. Corneal scrapes were sent for microbiological assessment. Variables studied were age, gender, risk factors, onset and duration of symptoms, best corrected visual acuity, treatment and complications. Data was analysed using SPSS 20. Of the 65 eyes of as many patients, 40(61.5%) were from female patients and 25(38.4%) from males. The most common local risk factor was ocular surgery 19(29.2%), followed by ocular trauma 15(23.1%). Diabetes was present in 29(44.6%) cases. Culture results after corneal scrapings were positive for 39(60%) samples, while 26(40%) had no growth. Bacterial growth was present in 20(51.3%) eyes, fungal in 11(28.2%) and polymicrobial organisms were present in 8(20.5%). The most common pathogens were pseudomonas 10(25.6%) that were most sensitive to ciprofloxacin. By the end of the follow-up, 40(61.5%) cases showed improvement. Isolated pseudomonas was the most common pathogen. Prompt diagnosis with culture sensitivity tests are needed in developing countries to avoid blindness due to infective corneal ulcers.

Factors associated with poor prognosis in corneal ulcer: A clinical and epidemiological study

Aim: To explore the factors associated with culture positivity and worsening of corneal ulcers in patients presenting to a tertiary care teaching hospital in south Kerala. Methods: We did a retrospective review of hospital-based case records from June 2018 to May 2019 and included all cases of infective corneal ulcer admitted during the period of study with corneal stromal infiltrate on slit-lamp examination. Results of gram stain, potassium hydroxide stain, and culture result were noted. The treatment history (moxifloxacin (0. 3%) or fortified cephalosporin and gentamicin or natamycin) was recorded. The data were exported to the statistical software SPSS V27.0 for further analysis. Results: The data of 125 culture-positive and 250 culture-negative ulcers were studied. Most patients were aged >55 years (n = 201, 53.6%) and 35–55 years (n = 120, 32.0%). The association of culture negativity with nontraumatic risk factors was significant (P = 0.01) but not with the size of the ulcer, progress score, or worsening clinical status of the ulcer. More persons with pretreatment (15.2%) showed worsening of the clinical status compared to those who did not (6.3%) (P = 0.005). 63% of the culture-positive cases had not taken any pretreatment. Compared to noncentral ulcers there was a marked deterioration of central ulcers (16.7%) (P = 0.005). Conclusion: Pretreatment and centrally located ulcers were significantly associated with a worsening clinical condition in this study. Culture-positive corneal ulcers showed a tendency toward improvement, but we could not find an association between the detection of the organism and its favorable response to treatment.

Microbial profile of infectious corneal ulcer in a remote Himalayan teaching hospital in Himachal Pradesh (India)

Purpose: To study the microbiological profile of clinically diagnosed infectious keratitis cases in tertiary care hospitals in Solan, HP (India). Design: The study design involves prospective cross-sectional study. Materials and Methods: It was a prospective cross-sectional study that included clinically diagnosed corneal ulcer patients from September 1, 2018 to September 1, 2019. The demographic data, predisposing risk factors, clinical details, previous treatment history, investigations, treatment, and visual outcomes were analyzed. Results: A total of 36 patients were included in the study, and no significant difference between the number of males and females was noted (P = 0.74). The most common etiology of ulcer was corneal trauma in 25 (69%) patients. Injury with vegetative material was the most common mode of injury (18 of 25, 72%), followed by injury during construction work (3 of 25, 12%). Twelve of 36 (33%) cases were fungal, 6 (16%) were found to be bacterial and 2 (5%) cases had mixed organisms. The most common organism isolated was Fusarium spp. in 8 (40%) cases. The most common bacterial isolate was Staphylococcus aureus in 4 (20%) cases, followed by one each of Streptococcus pneumonia (5%) and Pseudomonas spp. (5%). Thirteen patients (36%) reached outpatient department between 7 and 14 days and 15 (42%) patients 2 weeks after the start of symptoms with no significant difference in the two genders (P = 0.97). Conclusion: Majority of infectious corneal ulcers in our region are fungal due to injuries during predominantly agriculture-based lifestyles and need urgent management.