Clinical Characteristics, Histopathology, and Treatment Outcomes of Keratitis: A Retrospective Cohort Study

Overview

Journal Clin Ophthalmol

Publisher Dove Medical Press

Specialty Ophthalmology

Date 2021 May 3

PMID 33935486

Citations 16

Authors

Vilavun Puangsricharern

Patraramon Chotikkakamthorn

Wasee Tulvatana

Thanachaporn Kittipibul

Patchima Chantaren

Usanee Reinprayoon

Ngamjit Kasetsuwan

Vannarut Satitpitakul

Navaporn Worasilchai

Ariya Chindamporn

Affiliations

Soon will be listed here.

Abstract

Purpose: To identify factors associated with the prognosis in keratitis.

Patients And Methods: The medical records of 25 patients (26 eyes) diagnosed with keratitis at a referral institution were reviewed. The demographic and clinical characteristics, treatment, microbiological diagnosis, histopathological features, and outcomes were recorded. The histopathological specimens were reviewed. The patients were divided into a globe removal group and a globe salvage group. Univariate analysis was used to identify factors associated with poor outcomes.

Results: Fifteen eyes (57.7%) were removed. Patients in the globe removal group were on average 16.4 years older (95% CI 6.98 to 25.88) than those in the globe salvage group, received the first medication (either topical antifungals or antibiotics) later than one day after the onset of symptoms (RR = 2.75, 95% CI 1.18 to 6.42), and had a maximal diameter of the infiltration area ≥6 mm (RR = 3.14, 95% CI 1.17 to 8.45). The globe removal group showed satellite, multifocal, or total corneal infiltration patterns (RR = 2.82, 95% CI 1.03 to 7.74) and a hypopyon (RR = 3.43, 95% CI 1.26 to 9.35) as risk factors. The histopathological examination showed a higher density of in the globe removal group than the globe salvage group (median 376 (interquartile range 323, 620) versus 107 (interquartile range 16, 260) hyphae per high power field; = 0.035).

Conclusion: The risk of globe removal in patients with keratitis increased with age, delayed initial topical antifungal or antibiotic treatment, advanced disease at presentation, and dense hyphae infiltration of the cornea. Early recognition and treatment are critical to successfully eradicate the infection.

Citing Articles

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Outcomes of keratoplasty in a cohort of Pythium insidiosum keratitis cases at a tertiary eye care center in India.

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Depth, size of infiltrate, and the microbe - The trio that prognosticates the outcome of infective keratitis.

Agarwal S, Srinivasan B, Iyer G, Pandey S, Agarwal M, Dhiman R Indian J Ophthalmol. 2023; 72(1):44-50.

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