Age-related risk factors, culture outcomes, and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers
ABSTRACT To assess age-related risk factors (RFs), microbiologic profile, and prognosis of infectious keratitis and create guidelines for prevention and treatment.
Retrospective review of patients with infectious keratitis admitted to 2 Dutch tertiary referral centers from January 2002 to December 2004.
Forty-nine patients were admitted to the Academic Medical Center (Amsterdam) and 107 to the Rotterdam Eye Hospital. Mean age was 56.6 +/- 24.4 (SD) years; 49.4% were >or=60 years of age. The most common RFs among the elderly were systemic illness (36.4%), ocular surgery (33.8%), topical steroids (26%), blepharitis (20.8%), and herpetic eye disease (28.6%). This was significantly different from the most common RFs among younger patients (contact lens wear, 62.7%; chi2, P = 0.000). Gram-negative infections predominated (52.3%) and were more prevalent among younger patients (chi2, P = 0.000). Gram-positive infections prevailed among the elderly. Untreated patients had higher culture positive rates (68.7%) than patients treated with antibiotics before culturing (41.3%; chi2, P = 0.001). Elderly patients had a higher risk of perforations than younger patients (27.6% vs. 9.9%), a worse prognosis (mean VA, 6/30 vs. 6/10), and more often needed surgery (57.1% vs. 23.4%; P < 0.005 in all cases).
Infectious keratitis is a more severe disease in elderly than in younger patients with more complications and a worse prognosis. Elderly patients have multiple and more diverse risk factors, making prevention difficult. Prevention should aim at minimizing topical steroid use and controlling blepharitis, ocular surface disease, and herpetic eye disease. Initial antibiotic treatment should include sufficient coverage of Gram-positive pathogens.
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ABSTRACT: Purpose:To analyze the age distribution of corneal disease in China by histopathological examination. Methods:Methods: A retrospective histopathological analysis of the age distribution of corneal disease was performed on corneal specimens from 3112 patients who underwent corneal surgery between 2001 and 2012 in Henan Eye Institute. Results:The distribution of the corneal disease cases across age groups was significantly higher after age 30 (16.29%), reaching a peak by age 40 (22.04%) and remaining high until age 59 (21.05%, p < 0.01). The highest age-specific percentage of corneal infection was between the ages of 50 and 59 (83.21%, p < 0.001). The peak ages for corneal fungal infection were between the ages of 40 and 49 (51.46%) and 50 and 59 years (51.15%, p < 0.01); the peak age ranges for bacterial and viral infections were 70-79 (11.35%) and 10-19 (11.42%), respectively. The largest portion of other corneal diseases occurred in the age range of 10-19 years (42.47%) and 20-29 years (41.84%). Between the ages of 10 and 19, the leading pathologic diagnosis was keratoconus, accounting for 21.29% of cases; in contrast, the most common corneal diseases for patients aged 80 and above were Terrien-marginal degeneration (8.33%) and Mooren's ulcer (4.17%). The highest incidence of Corneal tumor was seen between ages of 0 and 9 years (65.83%) and by age 80 and older (45.83%) (p<0.01). Conclusions: The age distribution of corneal diseases in the Chinese population is distinct. The corneal diseases tend to increase in prevalence in middle age, especially for infectious corneal disease. The prevalence of corneal tumor is high in early and late life. Corneal degenerative disease occurs predominately in seniors.Investigative ophthalmology & visual science 04/2014; DOI:10.1167/iovs.13-13805 · 3.43 Impact Factor
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ABSTRACT: Purpose To determine whether topical corticosteroids as adjunctive therapy for bacterial keratitis improves long-term clinical outcomes. Design Randomized, placebo-controlled, double-masked clinical trial. Methods This multicenter trial compared 1.0% prednisolone sodium phosphate to placebo in the treatment of bacterial keratitis among 500 patients with culture-positive ulcers receiving 48 hours of moxifloxacin before randomization. The primary endpoint was 3 months from enrollment, and 399 patients were evaluated at 12 months. The outcomes examined were best spectacle-corrected visual acuity (BSCVA) and scar size at 12 months. Based on previous results, regression models with adjustments for baseline status and/or causative organism were used for analysis. Results No significant differences in clinical outcomes by treatment group were seen with the prespecified regression models (BSCVA: −0.04 logMAR, 95% CI, −0.12 to 0.05, P = .39; scar size: 0.03 mm, 95% CI, −0.12 to 0.18, P = .69). A regression model including a Nocardia-treatment arm interaction found corticosteroid use associated with a mean 1-line improvement in BSCVA at 12 months among patients with non-Nocardia ulcers (−0.10 logMAR, 95% CI, −0.19 to −0.02, P = .02). No significant difference was observed in 12-month BSCVA for Nocardia ulcers (0.18 logMAR, 95% CI, −0.04 to 0.41, P = .16). Corticosteroids were associated with larger mean scar size at 12 months among Nocardia ulcers (0.47 mm, 95% CI, 0.06-0.88, P = .02) and no significant difference was identified by treatment for scar size for non-Nocardia ulcers (−0.06 mm, 95% CI, −0.21 to 0.10, P = .46). Conclusions Adjunctive topical corticosteroid therapy may be associated with improved long-term clinical outcomes in bacterial corneal ulcers not caused by Nocardia species.American Journal of Ophthalmology 02/2014; 157(2):327–333.e3. DOI:10.1016/j.ajo.2013.09.025 · 4.02 Impact Factor
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ABSTRACT: The aim was to describe a geographically and clinically diverse sample of cases of Acanthamoeba keratitis (AK) and establish the risk factors for poor outcomes among patients with this disease. We conducted a retrospective, population-based case series of 116 patients with AK identified through a national surveillance network. Data were collected via a medical record review by diagnosing ophthalmologists and by phone interviews with patients. Exact logistic regression modeling was used to determine risk factors for poor visual outcomes. Among patients with data available on contact lens use, it was found that 93.3% wore contact lenses. The median time from symptom onset to care seeking was 2 days, whereas the median time from symptom onset to diagnosis was 27 days. Keratoplasty was performed in 27 of 81 patients with available outcome data and was more likely in patients >40 years old [odds ratio (OR) 5.25, 95% confidence interval (CI) 1.49-21.92]. When adjusted for age, the risk factors for keratoplasty included the presence of a ring infiltrate (OR 40.00, 95% CI 3.58-447.0) or any sign of stromal invasion (OR 10.48, 95% CI 2.56-55.09). One-third of patients with available data on best-corrected visual acuity had a best-corrected visual acuity <20/200, with the presence of a ring infiltrate as the only significant predictor of this outcome when adjusted for age (aOR 3.45, 95% CI 1.01-12.31). AK remains challenging to diagnose. Consequently, patients with advanced disease are more likely to have poor outcomes, particularly if they are older. The increasing awareness of AK among general eye care providers may shorten referral times and potentially improve outcomes.Cornea 12/2013; 33(2). DOI:10.1097/ICO.0000000000000014 · 1.75 Impact Factor