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Refractory Bacterial Keratitis: Risk Factors and Outcome
Mitali Vijay Mangoli1, Smruti Rekha Priyadarshini1, Srikant Kumar Sahu1
1Cornea & Anterior Segment Service, LV Prasad Eye Institute, Bhubaneswar, India.
Ocular Immunology and Inflammation
|October 30, 2025
Summary
Refractory bacterial keratitis, often linked to systemic issues and specific bacteria like Staphylococci, requires prompt management. Early identification of contributing factors is crucial for effective treatment and improved outcomes in non-healing corneal ulcers.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Bacterial keratitis can become refractory to standard medical therapy.
- Identifying factors contributing to non-healing corneal ulcers is essential for effective management.
Purpose of the Study:
- To investigate the causes, patient demographics, clinical presentation, and outcomes of refractory bacterial keratitis.
- To understand the factors influencing the development and progression of non-healing corneal ulcers.
Main Methods:
- A retrospective observational study analyzed 41 eyes of 40 patients with culture-proven bacterial keratitis unresponsive to ≥6 weeks of antibiotics.
- Inclusion criteria specified culture-proven bacterial keratitis and no surgery within 8 weeks of diagnosis, excluding other microbial causes or surgical intervention in non-responding cases.
Main Results:
- Staphylococci were the most common pathogens (51.2%).
- Common risk factors included uncontrolled diabetes mellitus, glaucoma, and ocular surface disorders.
- Twenty-two surgical interventions were performed, including therapeutic penetrating keratoplasty and tissue adhesive with bandage contact lens application.
Conclusions:
- Systemic conditions, ocular factors, and infecting organism characteristics contribute to refractory corneal ulcers.
- Early diagnosis and prompt management based on identified factors are vital for improving outcomes in bacterial keratitis.
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