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Profile of Microbial Keratitis
James Lim Wen Siang1, Ong Wu Zhuan1, Ngio Yi Chen1
1Ophthalmology, Taiping Hospital, Perak, MYS.
Purpose:
To study the demographic characteristics, predisposing factors, and latest trends of causative organisms and to analyze the prognostic factors of visual outcome in microbial keratitis.
Methods:
A retrospective study of patients diagnosed with microbial keratitis who required hospital admission in the period between January 2018 and December 2020 in Taiping Hospital, Perak, Malaysia.
Results:
A total of 75 eyes of 74 patients who were admitted to the hospital were studied. The male to female ratio was 13.8:1. Seventy percent of patients in this study were within the productive age group between 20 and 59 years old, with a mean age of 48 years old, and 51.4% of them were labourers. Cornea foreign bodies (42, 56%) were the most common predisposing factors and were associated with good visual outcomes (P<0.005). Other significant predictors for the final visual outcome were: presenting visual acuity, size of ulcer, duration of hospitalization, and duration of resolution. The mean duration of hospitalization was seven days. Corneal scrapings were done in all cases where 44 eyes (58.7%) were found to be positive for growth. Ten eyes (13.3%) that ended up with evisceration yielded a positive result. Gram-negative bacteria was the most prevalent causative organism of infective keratitis in the local/this region. Pseudomonas sp (20, 26.7%) being the most common bacterial isolate, was seen in all four contact lens-related cases and was associated with poor visual outcome and a high rate of evisceration. Patients who developed complications such as cornea melting (9, 12%), cornea perforation (11, 14.7%) and endophthalmitis (7, 9.3%) were associated with poor visual outcomes. Likewise, patients who required therapeutic interventions such as corneal gluing, tarsorrhaphy, and penetrating keratoplasty generally had poor visual outcomes (P<0.005; P=0.000008).
Conclusion:
Microbial keratitis is a major cause of ocular morbidity globally. Understanding the demographic and epidemiological characteristics of microbial keratitis of the region is important in the initial prompt treatment of the patients and may eventually improve the visual outcome.
Insights
This study found that corneal foreign bodies are a common cause of microbial keratitis, often leading to good visual outcomes. However, complications and specific bacteria like Pseudomonas sp. are linked to poor visual prognosis.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Epidemiology
Background:
- Microbial keratitis is a significant cause of visual impairment worldwide.
- Understanding regional demographic and etiological trends is crucial for effective management.
Purpose of the Study:
- To investigate demographic factors, predisposing causes, and causative organisms in microbial keratitis.
- To identify prognostic indicators for visual outcomes in affected patients.
Main Methods:
- A retrospective analysis of 75 eyes from 74 patients admitted with microbial keratitis between January 2018 and December 2020.
- Data collected included patient demographics, predisposing factors, microbiological results, complications, and visual outcomes.
Main Results:
- The majority of patients (70%) were aged 20-59, with a male predominance (13.8:1).
- Corneal foreign bodies were the most frequent predisposing factor (56%), associated with favorable visual outcomes.
- Gram-negative bacteria, particularly Pseudomonas sp. (26.7%), were the leading cause, linked to poor outcomes, especially in contact lens wearers. Complications like corneal melting, perforation, and endophthalmitis significantly worsened visual prognosis.
Conclusions:
- Microbial keratitis disproportionately affects the working-age population.
- Prompt identification of causative agents and risk factors, such as Pseudomonas sp., is vital for improving visual outcomes.
- Early and appropriate treatment, considering predisposing factors and complications, can mitigate ocular morbidity.
