Trends in follow-up visits and visual acuity gain in infectious keratitis: report from a tertiary eye care centre

Infectious keratitis (IK) is a leading cause of corneal blindness globally. While treatment can limit infection-related complications, the timeline and predictors of visual recovery in IK remain poorly characterised.

We conducted a retrospective cohort study of 966 patients (984 eyes) with non-viral IK at a tertiary eye care centre (2018-2023). Electronic health records were reviewed for microbiologic data, and best-corrected visual acuity (BCVA) measured at presentation and up to 90 days. Outcomes included change in BCVA evaluated across time intervals. Spearman correlation assessed associations between BCVA change and number of follow-up visits.

The average presenting BCVA was 1.04±0.95 logMAR (20/200), improving to 0.75±0.88 logMAR (20/112) at 90 days (-0.29 logMAR; p<0.001). The average number of follow-up visits was 4.18 days within the 90-day follow-up. 27.2% had culture-proven infections, predominantly bacterial (65.6%). Culture-positive cases had poorer initial vision (1.51±0.94 logMAR) but improved significantly (-0.43 logMAR; p<0.001). Most visual recovery occurred after 4 weeks of treatment. Poorer presenting BCVA correlated with higher follow-up visit frequency (ρ=0.37, p<0.001). A significant correlation was observed between BCVA improvement and number of visits (ρ=0.14, p<0.001). Bacterial keratitis showing better recovery than fungal, Acanthamoeba and polymicrobial infections. Surgical intervention was required in 3.5% of eyes, primarily in fungal, Acanthamoeba and polymicrobial cases.

Most visual improvement after IK occurs after 4 weeks, emphasising the need for continued follow-up and patient counselling regarding expected recovery timelines. Outcomes vary by initial severity and causative organism, highlighting opportunities for stratified management in IK.