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Risk factors in microbial keratitis leading to penetrating keratoplasty.
Ophthalmology 1999; 106(6):1166-70; discussion 1171O

Abstract

OBJECTIVE

To determine the characteristics of infectious corneal ulcers at the time of presentation to the cornea specialist associated with a favorable response to medical therapy versus a poor outcome manifested by the need for penetrating keratoplasty for therapy or visual rehabilitation.

DESIGN

Retrospective, case-control study.

PARTICIPANTS

A total of 162 patient records were reviewed, including the study group of 30 patients and the control group of 132 patients.

INTERVENTION

A retrospective review of all cases of microbial keratitis presenting to the Cornea Service between January 1, 1989 and December 31, 1995 was conducted. The cases were divided into two groups. The study group consisted of patients with microbial keratitis who failed medical therapy and required penetrating keratoplasty. The control group included patients with infectious ulcers who responded to medical therapy alone.

MAIN OUTCOME MEASURES

The influence of demographics, medical and ocular history, delay in presentation to the primary ophthalmologist or the corneal specialist, topical medications, and contact lens usage were compared. Visual acuity and ulcer characteristics were recorded. The statistical significance was evaluated by the chi-square test for independence and multiple logistic regression.

RESULTS

Older age (P=0.001), delay in referral to the corneal specialist (P<0.03), and treatment with topical steroids prior to presentation (P<0.0001) were statistically significant factors associated with the need for penetrating keratoplasty. Steroid use and the delay in referral were correlated. A past history of ocular surgery (P=0.01), poor visual acuity at presentation (P<0.001), and ulcer characteristics, including central location (P<0.0001), large size (P<0.0001), presence of perforation or descemetocele (P<0.0001), limbal involvement (P<0.0001), and hypopyon (P=0.05), were all associated with the need for penetrating keratoplasty.

CONCLUSIONS

Older age, delay in referral to the corneal specialist, topical steroid treatment, past ocular surgery, poor vision at presentation, large size, and central location of the ulcer are risk factors for poor outcome of microbial keratitis, as indicated by the need for penetrating keratoplasty.

Authors+Show Affiliations

Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10366087

Citation

Miedziak, A I., et al. "Risk Factors in Microbial Keratitis Leading to Penetrating Keratoplasty." Ophthalmology, vol. 106, no. 6, 1999, pp. 1166-70; discussion 1171.
Miedziak AI, Miller MR, Rapuano CJ, et al. Risk factors in microbial keratitis leading to penetrating keratoplasty. Ophthalmology. 1999;106(6):1166-70; discussion 1171.
Miedziak, A. I., Miller, M. R., Rapuano, C. J., Laibson, P. R., & Cohen, E. J. (1999). Risk factors in microbial keratitis leading to penetrating keratoplasty. Ophthalmology, 106(6), pp. 1166-70; discussion 1171.
Miedziak AI, et al. Risk Factors in Microbial Keratitis Leading to Penetrating Keratoplasty. Ophthalmology. 1999;106(6):1166-70; discussion 1171. PubMed PMID: 10366087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors in microbial keratitis leading to penetrating keratoplasty. AU - Miedziak,A I, AU - Miller,M R, AU - Rapuano,C J, AU - Laibson,P R, AU - Cohen,E J, PY - 1999/6/12/pubmed PY - 1999/6/12/medline PY - 1999/6/12/entrez SP - 1166-70; discussion 1171 JF - Ophthalmology JO - Ophthalmology VL - 106 IS - 6 N2 - OBJECTIVE: To determine the characteristics of infectious corneal ulcers at the time of presentation to the cornea specialist associated with a favorable response to medical therapy versus a poor outcome manifested by the need for penetrating keratoplasty for therapy or visual rehabilitation. DESIGN: Retrospective, case-control study. PARTICIPANTS: A total of 162 patient records were reviewed, including the study group of 30 patients and the control group of 132 patients. INTERVENTION: A retrospective review of all cases of microbial keratitis presenting to the Cornea Service between January 1, 1989 and December 31, 1995 was conducted. The cases were divided into two groups. The study group consisted of patients with microbial keratitis who failed medical therapy and required penetrating keratoplasty. The control group included patients with infectious ulcers who responded to medical therapy alone. MAIN OUTCOME MEASURES: The influence of demographics, medical and ocular history, delay in presentation to the primary ophthalmologist or the corneal specialist, topical medications, and contact lens usage were compared. Visual acuity and ulcer characteristics were recorded. The statistical significance was evaluated by the chi-square test for independence and multiple logistic regression. RESULTS: Older age (P=0.001), delay in referral to the corneal specialist (P<0.03), and treatment with topical steroids prior to presentation (P<0.0001) were statistically significant factors associated with the need for penetrating keratoplasty. Steroid use and the delay in referral were correlated. A past history of ocular surgery (P=0.01), poor visual acuity at presentation (P<0.001), and ulcer characteristics, including central location (P<0.0001), large size (P<0.0001), presence of perforation or descemetocele (P<0.0001), limbal involvement (P<0.0001), and hypopyon (P=0.05), were all associated with the need for penetrating keratoplasty. CONCLUSIONS: Older age, delay in referral to the corneal specialist, topical steroid treatment, past ocular surgery, poor vision at presentation, large size, and central location of the ulcer are risk factors for poor outcome of microbial keratitis, as indicated by the need for penetrating keratoplasty. SN - 0161-6420 UR - https://www.unboundmedicine.com/medline/citation/10366087/Risk_factors_in_microbial_keratitis_leading_to_penetrating_keratoplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(99)90250-6 DB - PRIME DP - Unbound Medicine ER -