Comparison of Clinical Features and Treatment Outcomes of Pseudomonas aeruginosa Keratitis in Contact Lens and Non-Contact Lens Wearers
Comparison of Clinical Features and Treatment Outcomes of Pseudomonas aeruginosa Keratitis in Contact Lens and Non-Contact Lens Wearers
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DOI：
10.1016/j.ajo.2021.02.024
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发表时间：
2021-04-15
影响因子：
4.2
通讯作者：
Jhanji, Vishal
中科院分区：
文献类型：
--
作者：
Enzor, Rikki;Bowers, Eve M. R.;Jhanji, Vishal
目的：比较隐形眼镜佩戴者(CLWS)和非隐形眼镜佩戴者(Non-CLWS)患铜绿假单胞菌角膜炎(PAK)的疗效，找出两组视力不良的危险因素。中心点设计：回顾性队列研究中心点方法：纳入自2006年1月至2019年12月连续的214例PAK病例。比较CLW组和非CLW组的临床特征、微生物学结果和疗程。中心点结果：在207例PAK患者中发现214只眼感染，其中CLWS组163只眼(76.2%)，非CLWS组51只眼(23.8%)。CLW患者的平均年龄为39.2岁，非CLW患者的平均年龄为71.9岁(P<；0.0001)。初诊时平均对数平均视力，CLW组为1.39，非CLW组为2.17(P<；0.0001)，最终视力分别为0.76和1.82(P<；0.0001)。13.5%的CLW和49.0%的非CLW的间质坏死需要手术或手术治疗(P<；.0001)。基于机器学习的分析得出了一系列临床特征，这些特征最能预测VA的不良结局(比20/40更差)，包括更差的初始VA，年龄更大，表现时浸润性或上皮缺损更大，以及更大的间质坏死最大深度。中心点结论：与CLW相比，非CLW的VA结局显著更差，需要更高的手术干预率。我们的研究阐明了患有PAK的非CLWS患者视力预后不良的危险因素。(AMJ眼科杂志2021；227：1-11。(C)2021 Elsevier Inc.保留所有权利。)
center dot PURPOSE: To compare the outcomes of Pseudomonas aeruginosa keratitis (PAK) in contact lens wearers (CLWs) and non-contact lens wearers (non-CLWs) and identify risk factors for poor visual acuity (VA) outcomes in each group. center dot DESIGN: Retrospective cohort studycenter dot METHODS: Two hundred fourteen consecutive cases of PAK were included between January 2006 and December 2019. Clinical features, microbiologic results, and treatment course were compared between CLW and non-CLW groups. Analyses of clinical features predicting poor final VA were performed.center dot RESULTS: This study identified 214 infected eyes in 207 patients with PAK, including 163 eyes (76.2%) in CLWs and 51 eyes (23.8%) in non-CLWs. The average age was 39.2 years in CLWs and 71.9 years in non-CLWs ( P < .0001). The average logMAR visual acuity (VA) at presentation was 1.39 in CLWs and 2.17 in non-CLWs ( P < .0001); average final VA was 0.76 in CLWs and 1.82 in non-CLWs ( P < .0001). Stromal necrosis required a procedural or surgical intervention in 13.5% of CLWs and 49.0% of non-CLWs ( P < .0001). A machine learning based analysis yielded a list of clinical features that most strongly predict a poor VA outcome (worse than 20/40), including worse initial VA, older age, larger size of infiltrate or epithelial defect at presentation, and greater maximal depth of stromal necrosis.center dot CONCLUSIONS: Non-CLWs have significantly worse VA outcomes and required a higher rate of surgical intervention, compared with CLWs. Our study elucidates risk factors for poor visual outcomes in non-CLWs with PAK.(Am J Ophthalmol 2021;227: 1-11. (c) 2021 Elsevier Inc. All rights reserved.)