Epidemiology, risk factors, and clinical outcomes in severe microbial keratitis in South India
Epidemiology, risk factors, and clinical outcomes in severe microbial keratitis in South India
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DOI：
10.1080/09286586.2018.1454964
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发表时间：
2018-01-01
影响因子：
1.8
通讯作者：
Burton, Matthew J.
中科院分区：
文献类型：
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作者：
Chidambaram, Jaya Devi;Prajna, Namperumalsamy Venkatesh;Burton, Matthew J.
目的：在这里，我们报告的危险因素与严重的细菌性角膜炎（BK），真菌性角膜炎（FK），阿米巴角膜炎（AK）在India.Methods：前瞻性观察性队列研究，在Aravind眼科医院，印度。招募患有严重微生物角膜炎（MK）的成年人（大小>= 3 mm），并随访至招募后21天。在就诊时记录溃疡的临床特征。最后一次访问的结果被分类为好（完全愈合或减少浸润大小）或穷人（扩大浸润大小，穿孔，或手术进行）。结果：252名参与者严重MK，191 FK，18 AK，19 BK，4混合BK/FK，20微生物学阴性。中位年龄为50岁（四分位距[IQR]：37-60岁），64%为男性，63%为农学家，45%未受过正规教育。72%的患者发生角膜创伤，出现症状前的中位症状持续时间为7天（IQR：5-15天）。与FK相关的临床特征为羽状边缘（p < 0.001）、凸起轮廓（p = 0.039）或干燥表面（p = 0.007）。BK组更可能出现前房积脓（p = 0.001），AK组更可能出现环形浸润（p < 0.001）。结局不佳的溃疡（n = 106/214）更有可能较大（比值比[OR]：1.63，95%置信区间[CI]：1.30-2.05，p < 0.001），发病时累及后角膜（OR：2.31，95% CI：1.16-4.59，p = 0.017），涉及曲霉属（OR：3.23，95% CI：1.26-8.25，p = 0.014），或发生在女性（OR：2.04，95% CI：1.03-4.04，p = 0.04）。即使在治疗后，34%（n = 76/221）有严重的视力障碍的最后vision.Conclusions：严重MK主要发生在农学家角膜创伤后，往往有不良后果。提供以社区为基础的眼保健服务可以使患者更早接受治疗，并改善预后。
Purpose: Here, we report risk factors associated with outcome in severe bacterial keratitis (BK), fungal keratitis (FK), and Acanthamoeba keratitis (AK) in India.Methods: Prospective observational cohort study conducted in Aravind Eye Hospital, India. Adults presenting with severe microbial keratitis (MK) were enrolled (size >= 3 mm) and followed to 21 days post-enrolment. Ulcer clinical features were recorded at presentation. Outcomes by final visit were classified as good (completely healed or reduced infiltrate size) or poor (enlarged infiltrate size, perforated, or surgery performed).Results: Of 252 participants with severe MK, 191 had FK, 18 had AK, 19 had BK, 4 had mixed BK/FK, and 20 were microbiologically negative. Median age was 50 years (interquartile range [IQR]: 37-60 years), 64% were male, 63% were agriculturalists, and 45% had no formal education. Corneal trauma occurred in 72%, and median symptom duration before presentation was 7 days (IQR: 5-15 days). Clinical features associated with FK were feathery margins (p < 0.001), raised profile (p = 0.039), or dry surface (p = 0.007). Hypopyon was more likely in BK (p = 0.001) and ring infiltrate in AK (p < 0.001). Ulcers with poor outcome (n = 106/214) were more likely to be larger (odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.30-2.05, p < 0.001), involve the posterior cornea at presentation (OR: 2.31, 95% CI: 1.16-4.59, p = 0.017), involve Aspergillus sp. (OR: 3.23, 95% CI: 1.26-8.25, p = 0.014), or occur in females (OR: 2.04, 95% CI: 1.03-4.04, p = 0.04). Even after treatment, 34% (n = 76/221) had severe visual impairment by the final visit.Conclusions: Severe MK occurred predominantly in agriculturalists post-corneal trauma and often had poor outcomes. Provision of community-based eyecare may allow earlier treatment and improve outcomes.