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The impact of the COVID-19 pandemic on microbial keratitis presentation patterns
Gibran F Butt1,2, Alberto Recchioni1,2, George Moussa2
1Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.
Background:
Microbial keratitis (MK) is the most common non-surgical ophthalmic emergency, and can rapidly progress, causing irreversible sight-loss. This study explored whether the COVID-19 (C19) national lockdown impacted upon the clinical presentation and outcomes of MK at a UK tertiary-care centre.
Methods:
Medical records were retrospectively reviewed for all patients with presumed MK requiring corneal scrapes, presenting between 23rd March and 30th June in 2020 (Y2020), and the equivalent time windows in 2017, 2018 and 2019 (pre-C19).
Results:
In total, 181 and 49 patients presented during the pre-C19 and Y2020 periods, respectively. In Y2020, concurrent ocular trauma (16.3% vs. 5.5%, p = 0.030) and immunosuppression use (12.2% vs 1.7%, p = 0.004) were more prevalent. Despite proportionately fewer ward admissions during the pandemic (8.2% vs 32.6%, p<0.001), no differences were observed in baseline demographics; presenting visual acuity (VA; median 0.6 vs 0.6 LogMAR, p = 0.785); ulcer area (4.0 vs 3.0mm2, p = 0.520); or final VA (0.30 vs 0.30 LogMAR, p = 0.990). Whilst the overall rates of culture positivity were similar in Y2020 and pre-C19 (49.0% vs. 54.7%, p = 0.520), there were differences in the cultures isolated, with a lower rate of poly-microbial cultures in Y2020 (8.3% vs. 31.3%, p = 0.022).
Conclusions:
Patient characteristics, MK severity and final visual outcomes did not appear to be affected in the first UK lockdown, despite fewer patients being admitted for care. Concurrent trauma and systemic immunosuppression use were greater than in previous years. The difference in spectra of isolated organisms may relate to behavioural changes, such as increased hand hygiene.
Insights
The COVID-19 lockdown did not significantly alter microbial keratitis (MK) patient outcomes or severity in the UK. However, there was an increase in concurrent trauma and immunosuppression use during this period.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Public Health
Background:
- Microbial keratitis (MK) is a leading cause of non-surgical vision loss.
- The COVID-19 pandemic prompted national lockdowns, potentially altering healthcare access and patient behaviors.
Purpose of the Study:
- To investigate the impact of the COVID-19 national lockdown on the clinical presentation and outcomes of microbial keratitis.
- To compare MK cases during the first UK lockdown with pre-lockdown periods.
Main Methods:
- Retrospective review of medical records for MK patients requiring corneal scrapes.
- Comparison of data from March 23rd to June 30th, 2020 (lockdown period) with equivalent periods in 2017-2019 (pre-lockdown).
Main Results:
- Fewer patients presented during the lockdown (49 vs. 181 pre-lockdown).
- Increased prevalence of concurrent ocular trauma and immunosuppression use during lockdown.
- No significant differences in presenting or final visual acuity, ulcer area, or overall culture positivity rates were observed.
- A lower rate of polymicrobial cultures was noted during the lockdown period.
Conclusions:
- The first UK COVID-19 lockdown did not negatively affect MK patient characteristics, severity, or visual outcomes.
- Increased concurrent trauma and immunosuppression were noted during the lockdown.
- Changes in microbial culture patterns may be linked to behavioral shifts, such as enhanced hygiene practices.
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