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Evaluating Medical Therapy Failure in Microbial Keratitis: Risk Factors and Management Alternatives.

David Lamas-Francis1,2, Daniel Navarro3, Raquel Mansilla4

  • 1Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.

Ocular Immunology and Inflammation
|November 26, 2024
PubMed
Summary
This summary is machine-generated.

Advanced age, deep corneal infiltrates, and prior steroid use are key risk factors for treatment failure in microbial keratitis (MK). Identifying these elements is crucial for effective management and surgical intervention decisions.

Keywords:
Corneakeratitismicrobial keratitisresistancetreatment failure

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Area of Science:

  • Ophthalmology
  • Infectious Diseases

Background:

  • Microbial keratitis (MK) is a significant cause of vision loss.
  • Understanding treatment outcomes and risk factors for failure is critical for patient management.

Purpose of the Study:

  • To describe treatments for infectious keratitis.
  • To identify risk factors for treatment failure, including prolonged infection, treatment modifications, and surgical intervention needs.

Main Methods:

  • Retrospective case series of culture-proven microbial keratitis.
  • Inclusion of 654 patients treated between 2010 and 2020 across nine hospitals in Galicia, Spain.

Main Results:

  • Prolonged infection linked to advanced age, deep infiltrates, corneal thinning, and large epithelial defects.
  • Treatment modification occurred in 31.2% of cases, often due to resistance or clinical deterioration.
  • Surgical intervention was needed in 21.7% of cases, with risk factors including prior keratoplasty, herpetic keratitis, steroid use, and large epithelial defects.

Conclusions:

  • Treatment failure in MK is influenced by systemic (e.g., advanced age) and ocular factors (e.g., large epithelial defects, polymicrobial infections, vegetable matter contact, prior steroid use).
  • Identifying these risk factors aids in guiding empirical treatment and managing refractory ulcers requiring intensive care or surgery.