Risk Factors, Microbiological Findings, and Clinical Outcomes in Cases of Microbial Keratitis Admitted to a Tertiary Referral Center in Ireland
Risk Factors, Microbiological Findings, and Clinical Outcomes in Cases of Microbial Keratitis Admitted to a Tertiary Referral Center in Ireland
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DOI：
10.1097/ico.0b013e3181877a52
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发表时间：
2009-04-01
期刊：
影响因子：
2.8
通讯作者：
Beatty, Stephen
中科院分区：
文献类型：
--
作者：
Saeed, Ayman;D'Arcy, Fiona;Beatty, Stephen
目的：探讨重症细菌性角膜炎（MK）的危险因素，并报道其微生物学结果和临床转归。方法：回顾性研究了2001年9月至2003年8月间三级转诊中心收治的所有疑似MK病例。记录的数据包括人口统计数据、与可能的危险因素有关的细节、微生物学研究结果、就诊时的临床发现以及临床和视觉结果。结果：90例患者在研究期间被诊断为疑似MK。患者平均年龄45±32岁，男女比例为47:43（52.2%:47.7%）。MK的易感危险因素包括隐形眼镜佩戴（37;41.1%）、前段疾病（19;21.1%）、眼外伤（13;14.4%）、全身性疾病（5;5.6%）和既往眼部手术（1;1.1%）。培养菌包括革兰氏阴性菌17株（51.5%），革兰氏阳性菌11株（33.3%）。棘阿米巴（2;6.1%）和真菌（1;3%）。治疗后视力明显改善[平均最佳矫正视力（+/-标准差）：0.76 (+/- 0.11)；末次随访平均最佳矫正视力：0.24 (+/- 0.07)；P < 0.001]。18例（20%）患者需要进行二次手术，包括点状烧灼术（1.1.1%）、角膜穿孔组织胶修复术（2.2.2%）、角膜修补术（9.9%）、肉毒杆菌毒素引起的上睑下垂（1.1.1%）、穿透性角膜移植术（3.3.3%）和内脏切除（2.2.2%）。结论：佩戴隐形眼镜仍然是严重MK的重要危险因素。MK仍然对视力和眼睛构成威胁，但大多数病例对及时和适当的抗菌药物治疗有反应。
Aim: To identify the risk factors for, and to report the microbiological findings and clinical outcomes of, severe microbial keratitis (MK).Methods: This was a retrospective study of all cases of presumed MK admitted to a tertiary referral center over a 2-year period (September 2001 to August 2003). Data recorded included demographic data, details relating to possible risk factors, results Of microbiological Studies, clinical findings at presentation, and clinical and visual outcomes.Results: Ninety patients were admitted with a diagnosis of presumed MK during the study period. The mean age of patients was 45 +/- 32 years, and the male to female ratio was 47:43 (52.2%:47.7%). Predisposing risk factors for MK included contact lens wear (37; 41.1%), anterior segment disease (19; 21.1%), ocular trauma (13; 14.4%), systemic disease (5; 5.6%), and previous ocular surgery (1; 1.1%). Cultured organisms included gram-negative bacteria (17; 51.5%), gram-positive bacteria (11, 33.3%). acanthamoeba (2; 6.1%), and fungi (1; 3%). Visual acuity improved significantly after treatment [mean best-corrected visual acuity (+/- standard deviation) at presentation: 0.76 (+/- 0.11); mean best-corrected visual acuity at last follow-up: 0.24 (+/- 0.07); P < 0.001]. Secondary surgical procedures were required in 18 (20%) cases, and these included punctal cautery (1; 1.1%)1 tissue glue repair of corneal perforation (2; 2.2%), tarsorrhaphy (9; 9.9%), Botulinum toxin-induced ptosis (1; 1.1%), penetrating keratoplasty (3; 3.3%), and evisceration (2; 2.2%).Conclusions: Contact lens wear remains a significant risk factor for severe MK. MK remains a threat to vision and to the eye, but the majority of cases respond to prompt and appropriate antimicrobial therapy.