Mikrobiyal keratitli hastaların demografik, laboratuvar ve klinik özelliklerinin analitik olarak incelenmesi

Öz

Amaç: Bu çalışmada mikrobiyal keratit tanısı alan hastalarda epidemiyolojik özellikler, klinik bulgular, risk faktörleri, direkt mikroskopi ve kültür sonuçlarını inceledik. Gereç ve yöntem: Mart 2016-Mart 2021 tarihleri arasında mikrobiyal keratit tanısı alan hastaların hastane kayıtları retrospektif olarak incelendi. Ayrıca klinik bulgular, risk faktörleri, mikrobiyolojik sonuçlar, ampirik tedavi ve tedaviye yanıt değerlendirildi. Bulgular: Yaş ortalaması 57,8 (dağılım 18-70) olan 42 hastanın 42 gözü çalışmaya dahil edildi. Boyalı mikroskopik incelemede 12 hastada (%28,5) gram-pozitif ve gram-negatif bakteriler saptandı. Toplamda 7 hastada kültürde üreme saptandı (%16,6), 35 hastada (%83,4) büyüme saptanmazken, 27 hastada (%64,4) etyolojik özellik saptanmadı, 24 hastada (%57,6) başvuru yakınmaları ağrı, 12 hastada (%28,8) kızarıklık şeklindeydi %) ve 6 hastada (%14,1) kızarıklık ve ağrı şikayetleri vardı. 18 olgunun tedavi sonrası görme düzeyleri korunurken, olguların 24'ünde (%88,8) tedavi ile 1 sıra ve üzeri görme artışı sağlandı. Tedavi öncesi ortalama görme keskinliği 0,79±1,1 (0-3,1) logMAR iken tedavi sonrası 0,69±1,1 (0-3,1) logMAR'a yükseldi (p=0,006). Sonuç: Keratit, tek taraflı körlüğün yaygın bir nedenidir. Keratitte erken tanı ve tedavi prognoz üzerinde önemli rol oynar. Bölgesel risk faktörleri ve sık görülen patojenler dikkate alınarak ampirik antimikrobiyal tedaviye başlanması tedavinin başarısı sağlayabilir.

Anahtar Kelimeler

• Etiyoloji
• keratit
• tedavi

Analytical investigation of demographic, laboratory, and clinical characteristics of patients with microbial keratitis

Öz

Purpose: In this study, we investigated epidemiological properties, clinical findings, risk factors, direct microscopy, and culture results in patients diagnosed with microbial keratitis. Materials and methods: We examined the hospital records of patients with microbial keratitis between March 2016 and March 2021, retrospectively. Also, clinical findings, risk factors, microbiological results, empirical treatment and, treatment responses were evaluated. Results: 42 eyes of 42 patients whose mean age was 57.8 (range 18-70 years) were included in the study. Grampositive and gram-negative bacteria were found on stained microscopic examination in 12 patients (28.5%). In total, microbial growth was detected in the culture of 7 patients (16.6%), while growth was not detected in 35 patients (83.4%). No etiological factor was detected in 27 patients (64.4%). The complaints at admission were pain in 24 patients (57.6%), redness in 12 patients (28.8%), and both redness and pain in 6 patients (14.1%). While the visual acuity of 18 cases was preserved after the treatment, 24 cases (88.8%) achieved 1 or more line with the treatment. While the mean visual acuity was 0.79±1.1 (0-3.1) logMAR before treatment, it increased to 0.69±1.1 (0-3.1) logMAR after treatment (p=0.006). Conclusion: The keratitis is a common cause of unilateral blindness. Early diagnosis and treatment of keratitis is a significant role in the prognosis. The success of the therapy can be provided by starting empirical antimicrobial therapy by taking into consideration of the regional risk factors and common pathogens.

Anahtar Kelimeler

• Etiology
• keratitis
• treatment

Kaynakça

1. 1. Austin A, Schallhorn J, Geske M, Mannis M, Lietman T, Nussbaumer JR. Empirical treatment of bacterial keratitis: an international survey of corneal specialists. BMJ open Ophthalmol 2017;2:e000047. https://doi.org/10.1136/BMJOPHTH-2016-000047
2. 2. Shah A, Sachdev A, Coggon D, Hossain P. Geographic variations in microbial keratitis: an analysis of the peer-reviewed literature. Br J Ophthalmol 2011;95:762-767. https://doi.org/10.1136/BJO.2009.169607
3. 3. Holden BA, Sankaridurg PR, Sweeney DF, Shretton S, Naduvilath TJ, Rao GN. Microbial keratitis in prospective studies of extended wear with disposable hydrogel contact lenses. Cornea 2005;24:156-161. https://doi.org/10.1097/01.ICO.0000138844.90668.91
4. 4. Ng ALK, To KKW, Choi CCL, et al. Predisposing factors, microbial characteristics, and clinical outcome of microbial keratitis in a tertiary centre in hong kong: a 10-year experience. J Ophthalmol 2015;2015:769436. https://doi.org/10.1155/2015/769436
5. 5. Lichtinger A, Yeung SN, Kim P, et al. Shifting trends in bacterial keratitis in Toronto: an 11-year review. Ophthalmology 2012;119:1785-1790. https://doi.org/10.1016/J.OPHTHA.2012.03.031
6. 6. Klotz SA, Penn CC, Negvesky GJ, Butrus SI. Fungal and parasitic infections of the eye. Clin Microbiol Rev 2000;13:662-685. https://doi.org/10.1128/CMR.13.4.662
7. 7. Schaefer F, Bruttin O, Zografos L, Guex Crosier Y. Bacterial keratitis: a prospective clinical and microbiological study. Br J Ophthalmol 2001;85:842-847. https://doi.org/10.1136/BJO.85.7.842
8. 8. Srinivasan M, Gonzales CA, George C, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol 1997;81:965-971. https://doi.org/10.1136/BJO.81.11.965

9. 9. Bharathi MJ, Ramakrishnan R, Meenakshi R, Padmavathy C, Shivakumar C, Srinivasan M. Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalmic Epidemiol 2007;14:61-69. https://doi.org/10.1080/09286580601001347
10. 10. Lam DSC, Houang E, Fan DSP, et al. Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America. Eye (Lond) 2002;16:608-618. https://doi.org/10.1038/SJ.EYE.6700151
11. 11. Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal crosslinking. J Cataract Refract Surg 2009;35:1358-1362. https://doi.org/10.1016/J.JCRS.2009.03.035
12. 12. Sharma N, Maharana P, Singh G, Titiyal JS. Pseudomonas keratitis after collagen crosslinking for keratoconus: case report and review of literature. J Cataract Refract Surg 2010;36:517-520. https://doi.org/10.1016/J.JCRS.2009.08.041
13. 13. Tewari A, Sood N, Vegad MM, Mehta DC. Epidemiological and microbiological profile of infective keratitis in Ahmedabad. Indian J Ophthalmol 2012;60:267-272. https://doi.org/10.4103/0301-4738.98702
14. 14. Morgan PB, Efron N, Hill EA, Raynor MK, Whiting MA, Tullo AB. Incidence of keratitis of varying severity among contact lens wearers. Br J Ophthalmol 2005;89:430-436. https://doi.org/10.1136/BJO.2004.052688
15. 15. Green M, Apel A, Stapleton F. A longitudinal study of trends in keratitis in Australia. Cornea 2008;27:33-39. https://doi.org/10.1097/ICO.0B013E318156CB1F
16. 16. Schaefer F, Bruttin O, Zografos L, Guex Crosier Y. Bacterial keratitis: a prospective clinical and microbiological study. Br J Ophthalmol 2001;85:842847. https://doi.org/10.1136/BJO.85.7.842
17. 17. Srinivasan M, Gonzales CA, George C, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol 1997;81:965-971. https://doi.org/10.1136/BJO.81.11.965