Corneal ulceration in the elderly in Hyderabad, south India
Corneal ulceration in the elderly in Hyderabad, south India
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DOI：
10.1136/bjo.84.1.54
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发表时间：
2000-01-01
影响因子：
4.1
通讯作者：
Rao, GN
中科院分区：
文献类型：
--
作者：
Kunimoto, DY;Sharma, S;Rao, GN
目的——报告印度南部三级眼保健中心老年患者角膜溃疡的人口统计学、微生物学、治疗、解剖和视觉结果。方法——对 65 岁及以上患者的 102 例微生物性角膜炎连续病例进行研究。纳入标准为：（i）裂隙灯检查时存在角膜基质浸润； (ii) 对疑似微生物性角膜炎的角膜刮片进行微生物学评估。 结果——本研究中确定的主要诱发因素是眼部疾病 (38.2%)、同一只眼睛既往进行过眼科手术 (29.4%)、外伤 (17.6%) 和严重全身性疾病 (16.7%)。仅两例 (2.0%) 与佩戴隐形眼镜有关。从 102 例病例中的 74 例（72.5%）的角膜刮片培养物中分离出 99 种微生物。表皮葡萄球菌（31.1%）、丝状真菌（25.7%）和肺炎链球菌（13.5%）是最常见的分离株。 12 只眼睛 (11.8%) 需要手术，15 只眼睛 (14.7%) 最终需要摘除内脏，94 名随访患者中的 9 名 (9.6%) 在最后一次随访中达到了 20/60 或更好的无辅助视力。 结论——这项工作代表了最近关于老年人（非病毒）微生物角膜炎、其管理和治疗结果的最大单中心研究。虽然诱发因素与一般人群不同，但导致老年人角膜炎的微生物谱似乎反映了当地的微生物菌群，而不是老年患者的偏好。诊断延迟和与年龄增长相关的全身状况可能导致治疗措施效果较差。
Aims-To report demographic, microbiological, therapeutic, anatomical, and visual results of corneal ulceration in the elderly patients seen at a tertiary eye care centre in south India.Methods-102 consecutive cases of microbial keratitis in patients 65 years and older were studied. Inclusion criteria were: (i) presence of corneal stromal infiltrate upon slit lamp examination; and (ii) microbiological evaluation of corneal scrapings for suspected microbial keratitis.Results-The principal predisposing factors identified in this study were ocular disease (38.2%), previous ocular surgery in the same eye (29.4%), trauma (17.6%), and severe systemic disease (16.7%). Contact lens wear was associated with only two cases (2.0%). 99 organisms were isolated in cultures of corneal scrapings from 74 (72.5%) of the 102 cases. Staphylococcus epidermidis (31.1%), filamentous fungi (25.7%), and Streptococcus pneumoniae (13.5%) were the most common isolates. 12 eyes (11.8%) required surgery, 15 (14.7%) eventually required evisceration, and nine (9.6%) of the 94 followed patients achieved an unaided vision of 20/60 or better at last follow up.Conclusions-This work represents the largest recent single centre study on (nonviral) microbial keratitis in the elderly, its management, and outcomes of therapy. While the predisposing factors differ from those of general population, the spectrum of microbes responsible for keratitis in the elderly appears to reflect the local microbial flora rather than a predilection for elderly patients. Delay in diagnosis and systemic conditions associated with advancing age probably contribute to poorer outcome from therapeutic measures.