[Severe bacterial keratitis referred to ophthalmology emergency departments: a retrospective study of 268 cases]
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1Unité d'ophtalmologie, pôle d'ophtalmologie et de chirurgie à dominante ambulatoire, Assistance publique-Hôpitaux de Paris, hôpital Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75004 Paris, France. geoffrey.dethorey@gmail.com
Purpose:
To investigate epidemiological, microbiological and clinical aspects of severe bacterial keratitis, in order to update current understanding of risk factors (RF) and prognosis.
Patients And Methods:
We conducted a monocentric retrospective study from January 2005 to January 2011, identifying and collecting data from inpatients admitted for severe documented bacterial keratitis.
Results:
We found 268 unilateral corneal ulcers. At least one local or systemic risk factor was identified in 255/268 patients (95%). The leading risk factor was contact lens wear (129/268), followed by underlying corneal disease (50/268) and prior corneal surgery (47/268). Initial and final visual acuities were 0.06 and 0.2 (1.20 and 0.72 LogMAR) respectively. Contact lens wear was associated with better prognosis and shorter hospitalization (P<0.05). Corneal healing was obtained in 255/268 patients (95%), with adjuvant surgery for 33 patients. The most frequently isolated pathogens were Gram+ cocci, more commonly associated with degenerative keratopathy or prior corneal surgery, and Gram- bacilli, more commonly associated with contact lenses (P<0.05). Both demonstrated a similar prognosis.
Conclusion:
Specific risk factors should be investigated in cases of severe bacterial keratitis. Contact lens wear is the most frequent risk factor, but with a better prognosis than underlying corneal disease, prior corneal surgery or systemic risk factors. The specific bacterial pathogen no longer appears to dramatically influence the outcome of severe corneal ulcers.
