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Risk factors for perforation in microbial corneal ulcers in north India
1Medical Services Directorate, Derbyshire Royal Infirmary, Derby, UK.
The British Journal of Ophthalmology
|March 15, 2006
Summary
Certain factors like outdoor work, illiteracy, and delayed treatment significantly increase the risk of corneal perforation in microbial keratitis patients. Prompt, fortified antibiotic treatment is crucial for preventing severe outcomes.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Public Health
Background:
- Microbial keratitis is a leading cause of corneal blindness globally.
- Corneal perforation is a severe complication that can lead to irreversible vision loss.
- Identifying risk factors is crucial for timely intervention and prevention.
Purpose of the Study:
- To identify predisposing factors associated with corneal perforation in patients diagnosed with microbial keratitis.
- To inform the development of targeted prevention and management strategies.
Main Methods:
- A case-control study involving 120 patients (60 with perforated corneal ulcers, 60 with healed/healing ulcers) in northern India.
- Matching cases and controls by age and presentation time.
- Utilizing a standardized proforma to collect demographic, social, medical, ocular, and treatment history data.
- Conducting detailed ocular examinations and relevant corneal scrapings.
Main Results:
- Factors significantly associated with corneal perforation included outdoor occupation, illiteracy, excessive alcohol use, ocular trauma (especially vegetable matter), poor initial vision, central ulcer location, and lack of corneal vascularization.
- Delayed initiation of treatment, failure to use fortified antibiotics, and monotherapy with fluoroquinolones were also significant risk factors.
- Logistic regression identified lack of corneal vascularization, delayed treatment, and inadequate fortified antibiotic use as key independent predictors of perforation.
Conclusions:
- Microbial keratitis patients with specific demographic, historical, and clinical characteristics are at higher risk of corneal perforation.
- Standardized referral and treatment protocols, particularly at the primary care level in developing countries, are essential for managing corneal ulcers and preventing perforation.
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