Characteristics of Infectious Keratitis in Old and Very Old Patients

The aim of this study was to analyze patient backgrounds, including activities of daily living (ADL) and living status, predisposing risk factors, causative agents, and severity with infectious keratitis in old (75 < 85 years of age) and very old (≥85 years of age) patients.

We retrospectively reviewed 54 old patients who were hospitalized for infectious keratitis. The focus occupancy ratio (FOR) was defined as the total focus area/entire cornea area.

The mean patient age was 82.9 ± 5.6 years. There were 33 old and 21 very old patients. Dementia was found in 8 patients (14.8%), but the most common predisposing risk factor was post-keratoplasty (15 patients, 27.8%). However, 10 patients (18.5%) had unknown risk factors. In all, 16 patients (29.6%) had low ADL, including being bedridden or being unable to go outside without assistance, and 19 patients (35.2%) lived alone. Causative agents were detected in 31 patients (57.4%) and included bacteria in 22 patients and fungi in 9 patients. Seventeen patients (31.5%) had >25% focus size of the corneal area. The average FOR was 12.1% ± 14.1%, and the mean best-corrected visual acuity (BCVA) at the first and final visits was 1.88 ± 0.71 and 1.52 ± 1.03 logMAR, respectively. Multivariate analyses showed that age correlated with FOR and the final BCVA.

Infectious keratitis in old and very old patients is likely to be severe due to low ADL and social environment. Ophthalmologists should take care to identify keratitis during its early stage in these patients.