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Infectious keratitis in pediatric population aged less than two years: a tertiary eye institute experience
Mohammad Soleimani1,2, Seyed Mahbod Baharnoori1,2, Sadegh Ghafarian1
1Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.
Insights
Infectious keratitis in children under two years old often requires surgery, despite effective medical treatments. Prompt referral and corneal sampling are crucial for managing this serious eye condition.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Infectious keratitis is a significant cause of vision loss, particularly in children.
- Data on infectious keratitis in children under two years old is limited.
- This study addresses the lack of comprehensive data in this specific pediatric population.
Purpose of the Study:
- To identify predisposing factors for infectious keratitis in children under two years.
- To characterize the clinical presentation and microbial profile of infectious keratitis in this age group.
- To evaluate management strategies and outcomes for infectious keratitis in infants and toddlers.
Main Methods:
- A retrospective study was conducted over 18 years (July 2005 - December 2022) at a tertiary eye institute.
- Data collected included demographics, predisposing factors, clinical features, and treatment methods.
- Analysis focused on 57 cases of infectious keratitis in children aged 1-24 months.
Main Results:
- Predisposing factors were present in 68.4% of cases, including ocular trauma and intraocular surgery.
- Corneal thinning occurred in 50.9%, with 22.8% progressing to perforation.
- Pseudomonas aeruginosa was the most common pathogen; 26.3% of cases required tectonic surgical procedures.
Conclusions:
- Surgical intervention is frequently necessary for infectious keratitis in young children, even with appropriate medical therapy.
- Early detection, prompt referral, and timely corneal sampling are essential for optimal management.
- Understanding predisposing factors and microbial patterns aids in guiding treatment decisions.
Background:
Infectious keratitis is a serious ocular condition, which can lead to corneal scarring, vision loss, and even blindness. Pediatric infectious keratitis accounts for about 13% of all cases, although there is a lack of comprehensive data regarding keratitis in less than two years of age population group. This study was aimed to determine predisposing factors, clinical characteristics, microbial profile, and management of infectious keratitis in a population of children aged less than two years.
Materials And Methods:
A retrospective study was carried out in a tertiary eye institute over a period of 18 years from July 2005 to December 2022. Collected data was analyzed for demographics, predisposing factors, clinical features, and treatment methods.
Results:
Fifty-seven cases of keratitis were identified. Age of the patients ranged from 1 to 24 months (Median: 6, interquartile range: 2-10). Thirty cases were male (52.6%). Predisposing factors were identified in 39 cases (68.4%): consisting of prior ocular trauma (n = 15), previous intraocular surgery (n = 11), ocular surface disease (n = 10), nasolacrimal duct obstruction (n = 4), prematurity (n = 3), developmental delay (n = 2), TORCH infection (n = 1), and contact lens (n = 1). Corneal thinning was observed in 29 eyes (50.9%), which progressed to perforation in 13 eyes (22.8%). Three patients developed endophthalmitis (95% CI, 1.5-13.4%). Most eyes had negative smear (60.4%) and culture (59.6%) results. Pseudomonas aeruginosa was the most common microorganism (11 of 21). Candida albicans was isolated in one case. In vitro susceptibility results showed good coverage of the combined ceftazidime and vancomycin regimen (100%). Surgical procedures were carried out in 35 eyes (61.4%) and 15 eyes required tectonic procedures (26.3%).
Conclusion:
Despite good coverage of medical treatment over cultured isolates, surgical tectonic intervention was required in nearly a quarter of cases to resolve the corneal infection. This finding indicates the necessity of prompt patient referring, corneal sampling and initiation of the treatment.
