Refractory Bacterial Keratitis: Risk Factors and Outcome

To evaluate the aetiology, demographic profile, clinical features, and outcomes in cases of refractory bacterial keratitis.

This is a retrospective observational study in which 41 eyes of 40 patients diagnosed with bacterial keratitis, with no improvement after medical therapy, were evaluated. The inclusion criteria were as follows: (a) culture-proven bacterial keratitis; (b) antibiotic usage of ≥6-weeks; (c) No surgery within 8-weeks of diagnosis. The exclusion criteria were as follows: (a) other causes of microbial keratitis and (b) surgical intervention in non-responding keratitis within 8-weeks.

Forty-one eyes of 40 patients were analysed in this study. Thirty eyes (73.2%) had an ulcer area of about 15-20 mm². The visual acuity varied from 0 logMAR in ulcers with small size to no light perception due to the nature of the corneal infiltrate. Common risk factors noted in the patients were systemic comorbidities like uncontrolled diabetes mellitus, glaucoma, and ocular surface disorders. Staphylococci were the predominant organisms, found in 21 (51.2%) eyes. Twenty-two surgical interventions were performed including one eye which had to undergo evisceration. This included eight tissue adhesive and bandage contact lens application (TA+BCL), five intracameral antibiotic injections, five therapeutic penetrating keratoplasty (Th.PK).

Various factors can contribute to the development of non-healing or refractory corneal ulcers including systemic conditions, ocular factors, and the characteristics of the infecting organism. Identification of these factors can aid in early diagnosis and prompt management of the condition.