A thirteen-year tertiary centre experience with infectious keratitis in the elderly population

This study aims to elucidate the classification, clinical presentation, follow-up, and treatment outcomes of elderly patients diagnosed with infectious keratitis.

This retrospective single-center analysis, conducted at a tertiary ophthalmology center (Ege University Medical Faculty Hospital, Department of Ophthalmology, Izmir, Turkiye), included 317 patients aged ≥ 60 years diagnosed with infectious keratitis between January 2012 and January 2025. Microbiological culture results, clinical course, comorbidities, treatments, and outcomes were evaluated.

The female-to-male ratio was 0.89 and the mean age was 72.1 ± 7.23 years (range: 60-96 years). Positive culture results were identified in 128 (40.4%) of 317 patients, with 81 (63.3%) bacterial and 47 (36.7%) fungal infections. Streptococcus pneumoniae (29.7%) was the most common pathogen. Most lesions were central/paracentral (89.9%) and single (79.2%). The mean best-corrected visual acuity (BCVA) improved from 2.33 ± 0.99 LogMAR to 1.99 ± 1.08 LogMAR (95% CI, 0.15-0.53; paired-samples t test, p < 0.001). Most patients (76.3%) responded favorably to empirical treatment. Recurrence occurred in 34 patients, 22 required corneal transplantation, and 9 underwent evisceration. Dry eye (43.8%) and systemic immunosuppression (36.9%) were the most common comorbidities.

In the present study, differing from some others that report coagulase-negative Staphylococci as the predominant agent in elderly infectious keratitis patients, the most common pathogen was Streptococcus pneumoniae. This finding highlights potential regional or methodological differences. The presence of dry eye and systemic immunosuppression significantly influenced unfavorable outcomes, emphasizing the importance of addressing these risk factors. Tailored treatment strategies may improve outcomes in this population.