Outcome Of Microbial Keratitis Research Articles

Incidence and outcomes of microbial keratitis after cyclophotocoagulation to treat childhood refractory glaucoma

To report the incidence and outcomes of microbial keratitis (MK) following cyclophotocoagulation (CPC) for treatment of refractory childhood glaucoma (CG) at a single center over a period of 6 years. In this cohort study, the medical records of children with CG who underwent CPC and subsequently presented with MK from 2014 to 2020 were reviewed retrospectively. Data were collected on age, type of glaucoma, surgeries before MK, CPC parameters, interval between CPC and MK, presenting symptoms of MK, infiltrate location, bacterial isolates, MK treatment, and outcomes. Among the 312 children who underwent CPC during the study period, 37 eyes of 33 children had MK, with an incidence of 1.8% (95% CI, 0.3-3.2). The median interval between CPC and MK was 4 years (IQR, 2.7-7.4). CPC was repeated once in 20 eyes (54%) and twice in 4 (11%). In 20 eyes, there was no pain at MK onset. The primary isolates were Streptococcus pneumoniae (12/27 [22%]) and Staphylococcus epidermis (8/27 [30%]). MK resolved in 17 eyes (46%) after treatment; 8 eyes (22%) underwent evisceration or had phthisis, and keratoplasty failed in 6 eyes (16%). The absence of pain at presentation with MK was negatively associated with resolution (OR = 5.0 [95% CI, 1.1-23.8]; P = 0.04). The absence of pain at MK onset may be a proxy for neurotrophic keratitis after CPC and is linked to poor response to management.

Microbial keratitis and clinical outcomes following penetrating and endothelial keratoplasty.

The goal of this study was to review the incidence, risk factors and outcomes of microbial keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). The electronic medical records at Wills Eye Hospital were queried for cases of microbial keratitis following PK or EK performed between 1 May 2007 and 1 September 2018. Charts were reviewed to obtain demographic data, transplant characteristics, details of microbial keratitis, graft survival and clinical outcomes. During the study period, 2098 transplants were performed in 1601 patients. Of these, 1267 (60.4%) were PKs and 831 (39.6%) were EKs. We identified 86 (4.1%) cases of subsequent microbial keratitis. The incidence of microbial keratitis after PK was significantly higher than after EK (5.9% versus 1.3%; p=0.005). Furthermore, the rate of infection was higher after repeat transplants (either PK or EK) compared to initial keratoplasties (5.5% versus 3.4%; p=0.02). Twenty-six (32.1%) grafts remained clear at most recent follow-up after microbial keratitis, and the proportion of clear grafts was higher after EK than PK (66.7% versus 27.8%; p=0.03). Rates of microbial keratitis were significantly higher after PK compared to EK, and repeat transplantation was a risk factor for microbial keratitis. To the best of our knowledge, there is no prior study in the literature evaluating microbial keratitis rates after PK and EK and comparing outcomes.

Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study.

Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: Out of 313 participants enrolled, 188 reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged.

Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study

Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: Out of 313 participants enrolled, 188 reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged.

Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study

Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: 188 out of 313 participants reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged.

Microbial Keratitis Secondary to Therapeutic Contact Lens Wear

Therapeutic contact lenses are commonly used to treat various ocular surface conditions that require restoration or maintenance of the corneal epithelium. While this is a very successful treatment modality, it is not without risk. The primary risk associated with bandage contact lens wear is microbial keratitis. This paper will review the literature on the occurrence and outcomes of microbial keratitis in the setting of therapeutic contact lens use, including orthokeratology. Therapeutic contact lenses are used in various situations including ocular surface disease, post-keratorefractive surgery, and post-corneal crosslinking. Orthokeratology utilizes a rigid contact lens for therapeutic purposes. Though an uncommon occurrence in the setting of therapeutic contact lenses, microbial keratitis can occur and can lead to vision loss even in the setting of prophylactic topical antibiotics. Despite improvements in contact lens materials that would reduce infection rates, use of modern therapeutic contact lenses can still result in microbial keratitis, even with the use of prophylactic antibiotics. Although incidence rates for microbial keratitis in with therapeutic contact lens use are not available, numerous reports confirm that care must be taken when using therapeutic contact lenses to avoid sight-threatening infections.

The epidemiology of nonviral microbial keratitis in a tertiary care center in Muscat, Oman.

OBJECTIVE:The objective of this study is to describe the epidemiology, risk factors, etiology, and outcome of microbial keratitis in a tertiary care center in Muscat, Oman.METHODS:The electronic records of all patients diagnosed with keratitis or corneal ulcer between January 2013 and January 2016 in Al-Nahdha Hospital were retrospectively reviewed. Patients who presented with a corneal ulcer requiring admission and who underwent culture and sensitivity studies were included in the study. Patients with viral keratitis or sterile corneal ulcers were excluded from the study.RESULTS:A total of 606 electronic medical records of all presumed microbial keratitis were reviewed. Out of these, 304 met the eligibility criteria. The mean age of patients was 52.2 years (standard deviation [SD]: ±23.2 years; range: 0.1–89 years). A total of 198 (65%) microbial cultures yielded positive results. Of these, 182 (92%) were bacterial, 13 (7%) were fungal, and 3 (1%) cases were due to a combined (bacterial and fungal) etiology. Gram-positive bacteria accounted for 102 (55.1%), of which the majority was due to Streptococcus pneumoniae. Gram-negative bacteria accounted for 77 (41.6%) cases; half were caused by Pseudomonas aeruginosa. Keratitis in patients aged 18 years and younger was more likely to be associated with trauma (48.3%, P < 0.001) in young adults with contact lens wear (64%, P < 0.001) and in adults over 40 years with blepharitis (55.6%), sequelae of previous trachoma infection (26.3%), and eyelid abnormalities (18.4%). Following recovery, corneal scarring was seen in 63.2% of patients.CONCLUSION:Microbial keratitis affects patients of all age groups but is more common in older adults. The vast majority of culture-proven cases are due to bacterial infections. Children and teenagers are more likely to develop keratitis following eye trauma whereas young adults mostly develop the condition in association with contact lens wear. Ocular surface disease is the most important risk factor in older adults. The majority of patients end up with corneal scarring.

Evolving risk factors and antibiotic sensitivity patterns for microbial keratitis at a large county hospital

Purpose: To identify the risk factors, causative organisms, antimicrobial susceptibility and outcomes of microbial keratitis in a large county hospital in Houston, Texas.Design: Case series.MethodsSetting: A large county hospital in...

Presentation and Outcome of Microbial Keratitis in Ilorin, Nigeria

Aim: To determine the presentation and outcome of microbial keratitis among patients at University of Ilorin Teaching Hospital (UITH) in Ilorin, Nigeria. Methods: A 12-month, prospective, hospital-based longitudinal study was conducted by examining all patients with clinical features of infective keratitis, who met the inclusion criteria. A posttreatment evaluation was done at 6 weeks in all cases, during which visual acuity and any complications were re-assessed. The outcome measures included interval between onset and presentation, extent of corneal involvement and final visual acuity. The data was analysed with the SPSS version 20.0 software. Results: Fifty-five eyes of 54 patients were studied. There were 32 males (59.3%) and 22 females (40.7%). The mean age was 36.9 years (± 12.1). The predisposing factors were trauma in 30 (55.6%) cases, self-medication with topical steroids in 12 (22.2%) and the use of traditional eye Original Research Article Saka et al.; BJMMR, 6(8): 795-803, 2015; Article no.BJMMR.2015.253 796 medication in 12 (22.2%). All of the participants presented with pain, tearing, photophobia and reduction in vision. The right eye was involved in 37 patients (67.2%). The presenting visual acuity in the affected eyes was 6/60 or less in 31 (56.4%), 6/60–6/24 in 18 (32.7%) and 6/6–6/18 in 6 eyes (10.9%). At 6-week follow-up, 5 eyes (9.1%) had <6/60 visual acuity, 40 (72.7%) had 6/60– 6/24 and 10 (18.2%) had 6/6–6/18.The risk factors for poor outcome were a centrally located lesion (p=0.018), an area of corneal involvement greater than 4mm (p=0.007) and a lesion affecting the deeper layers of the cornea (p=0.002). Conclusion: Microbial keratitis is a significant cause of ocular morbidity, and public eye-health education is highly desirable as a preventive measure.

Microbial Keratitis in East Africa: Why are the Outcomes so Poor?

Purpose: Microbial keratitis (MK) is a major cause of blindness in Africa. This study reports the epidemiology, causative organism, management and outcome of MK in people admitted to a large referral hospital in Northern Tanzania, and explores why the outcomes are so poor for this condition.Methods: A retrospective review of all admissions for MK during a 27-month period. Information was collected on: demographics, history, examination, microbiology, treatment and outcome.Results: A total of 170 patients with MK were identified. Presentation was often delayed (median 14 days), and more delayed if another health facility was visited first (median 21 days). Appropriate intensive antibiotic treatment was prescribed in 19% before admission. Lesions were often severe (41% >5mm). Filamentary fungi were detected in 25% of all specimens (51% of specimens with a positive result). At discharge, 66% of affected eyes had a visual acuity of less than 6/60. Perforations developed in 30% and evisceration was necessary in 8%. Perforation was associated with large lesions and visiting another health facility. HIV infection was diagnosed in 16% of individuals tested, which is approximately twice the prevalence found in the wider population.Conclusions: Microbial keratitis is a significant clinical problem in this region, which generally has a very poor outcome. Delayed presentation is a critical issue. Fungal keratitis is a prominent cause and there is an indication that HIV may increase susceptibility. Prompt recognition and appropriate treatment in primary/secondary health facilities and rapid referral when needed may reduce the burden of blindness from this disease.

Microbial Keratitis Pathogens and Antibiotic Susceptibilities: A 5-Year Review of Cases at an Urban County Hospital in North Texas

To review the epidemiology, risk factors, microbiologic spectrum, and outcomes of microbial keratitis and to compare cases in which a causative organism is identified to those determined to be sterile during a 5-year period at a large county hospital in north Texas. A retrospective chart review of cases of microbial keratitis at Parkland Memorial Hospital between January 2000 and December 2004. During this 5-year period, 132 eyes of 131 patients underwent 139 corneal scrapings for presumed microbial keratitis and an organism was reported in 73 (52.5%) cultures. Including abnormal confocal microscopy results, a causative organism was determined in 78 (56.1%) cases. At least one risk factor was present in 115 (87.1%) cases, with the most common risk factors being preexisting ocular disease, contact lens wear, and a history of trauma. Nearly 5% of patients reported a history of cocaine use. Gram staining correctly identified the organism in 20 (28.6%) culture-positive cases, and Pseudomonas aeruginosa was the most common isolate, followed by Staphylococcus aureus. The rate of S. aureus resistance to fluoroquinolones (15.4%) was similar to rates previously reported from the early to mid 1990s, but less than those reported from the late 1990s. Severe complications were more common in the nonsterile subgroup (34.2%) than in the sterile (16.9%) subgroup (P=0.041). Although the rate of acute intervention was higher in the nonsterile subgroup (27.4%) than in the sterile subgroup (20.3%), this difference was not statistically significant (P=0.461). Mean logMAR visual acuity was 1.451 (Snellen equivalent, 20/563) at presentation and 1.062 (20/231) at the last follow-up visit (P<0.001). Presenting and final visual acuities were significantly better in the sterile subgroup than in the nonsterile subgroup (P<0.001 and P=0.002, respectively). When a causative organism is not identified in microbial keratitis, visual acuity is not as severely affected, and fewer severe complications occur. Antibiotic resistance to fluoroquinolones and aminoglycosides, though not common, still deserves consideration in the treatment of microbial keratitis.

Evaluation of risk factors and treatment outcome of microbial keratitis in a tertiary eye center

Purpose: To evaluate the risk factors and treatment outcome of microbial keratitis in a tertiary eye care centre. Methods: A hospital based prospective study in clinically diagnosed cases with microbial keratitis were enrolled. Corneal scrapes taken and subjected to direct microscopy and culture. Empirical treatment initiated following smear report and definitive treatment commenced after culture and sensitivity report. Patients were followed up for 3 months. Treatment outcome was assessed on the basis of signs of healing, scar formation, necessity of surgical intervention and severe complications. Results: A total of 95 patients were included. Microbial keratitis was common in the age group of 51-60 years with male preponderance. It was common in people involved in agricultural works, and frequent during the agricultural season of monsoon and spring. Among the predisposing factors, history of ocular trauma with vegetative matter is common. Majority presented before 14 days of onset of symptoms and also had history of prior treatment. Organisms were identified under direct microscopy in (38.9%) of cases and isolated in (51.6%) in culture medium. Streptococcus pneumoniae (22.1%) and Aspergillus (7.3%) were the most common bacterial and fungal isolate respectively. In vitro antibiotic sensitivity demonstrated bacteria were most sensitive to ofloxacin. A total of (75.8%) patients achieved complete healing whereas (10.5%) required surgical intervention. Conclusion: Early presentation, medication compliance and timely intervention can lead to good clinical and visual outcome in patients with microbial keratitis.