Age-related Risk Factors, Culture Outcomes, and Prognosis in Patients Admitted With Infectious Keratitis to Two Dutch Tertiary Referral Centers
Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands. Cornea
(Impact Factor: 2.04).
06/2008; 27(5):539-44. DOI: 10.1097/ICO.0b013e318165b200
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.
Available from: Alastair K Denniston
- "Of interest, is the observation that the severity of ocular surface infections such as microbial or herpetic keratitis is clinically worse in the elderly (van der Meulen et al. 2008) and autoimmune diseases e.g. Mucous Membrane Pemphigoid (Foster 1986; Chan 2001) typically affect people in later life. "
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ABSTRACT: The conjunctiva is a highly specialized ocular mucosal surface that, like other mucosa, houses a number of leukocyte populations. These leukocytes have been implicated in age-related inflammatory diseases such as dry-eye, but their phenotypic characteristics remain largely undetermined. Existing literature provides rudimentary data from predominantly immunohistochemical analyses of tissue sections, prohibiting detailed and longitudinal examination of these cells in health and disease. Using recovered cells from ocular surface impression cytology and flow cytometry, we examined the frequency of leukocyte subsets in human conjunctival epithelium and how this alters with age. Of the total CD45+ leukocyte population within the conjunctival epithelium, 87% [32-99] (median) [range] comprised lymphocytes, with 69% [47-90] identified as CD3 + CD56- T cells. In contrast to peripheral blood, the dominant conjunctival epithelial population was TCRαβ + CD8αβ + (80% [37-100]) with only 10% [0-56%] CD4+ cells. Whilst a significant increase in the CD4+ population was seen with age (r = 0.5; p < 0.01) the CD8+ population remained unchanged, resulting in an increase in the CD4:CD8 ratio (r = 0.5;p < 0.01). IFNγ expression was detectable in 18% [14-48] of conjunctival CD4+ T cells and this was significantly higher among older individuals (<35 years, 7[4-39] vs. >65 years, 43[20-145]; p < 0.05). The elevation of CD4+ cells highlights a potentially important age-related alteration in the conjunctival intra-epithelial leukocyte population, which may account for the vulnerability of the aging ocular surface to disease.
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ABSTRACT: In older patients, the prevalence of many ocular infections is increased.
Increased risk of infection is due to multiple factors (described herein) that are amenable to intervention.
In older patients, the severity of ocular infections, when they occur, can be greater than those of younger patients.
Response to treatment may be poor in elderly patients, necessitating more aggressive or prolonged treatment.
Older patients may have problems self-administering topical treatment effectively.
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ABSTRACT: To identify the associated factors and study the clinical and microbiological characteristics of corneal ulcers resulting in evisceration and enucleation in elderly patients in a tertiary care hospital.
A review of all patients who required evisceration or enucleation due to microbial keratitis at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia between July 1998 and November 2007 was performed. Of these, patients more than 60 years of age were included in the study for analysis.
Forty-seven patients with microbial keratitis were included in the study. The mean age of patients was 81 +/- 9.39 years. Major ocular factors associated were glaucoma (49%), persistent corneal epithelial defect (38%) and use of corticosteroid eye drops (23%). Most common associated systemic factor was rheumatoid arthritis (36%). The indications for evisceration or enucleation were extensive non-healing microbial keratitis (22/47) and corneal perforation secondary to microbial keratitis (17/47). Pseudomonas aeruginosa was the most common pathogen, present in 15 patients, and more than 45% of the strains tested were resistant to chloramphenicol.
Corneal ulcers that result in the loss of eye in elderly population are frequently associated with glaucoma and persistent epithelial defects. The majority of these cases have non-healing microbial keratitis caused by Pseudomonas aeruginosa.
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