Study of epidemiological characters, predisposing factors and treatment outcome of corneal ulcer patients
Keywords:
corneal ulcer, evisceration, fungal, scraping, snellen acuity, staining
Abstract
Introduction: Corneal ulcer is one of the common reasons for ophthalmic OPD and IPD visit. It is responsible for vision loss inlarge number of patients. We have conducted this study to evaluate epidemiological characteristics, predisposing factors and treatment outcome of corneal ulcer patients in tertiary care teaching hospital.
Method: A prospective study of corneal ulcer patients from Dec 2009 to Nov 2013 was done. Data related to socio-demography, predisposing factors, prior treatment and duration of symptoms were recorded. Ulcer was evaluated by slit lamp examination. Corneal scrapings were subjected to Gram`s stain and 10% KOH wet mount.
Results: 432 eyes were evaluated.53.9% were between 26-45 yrs.71.06% eyes presented with vision <3/60. Trauma was commonest factor found in 53.93% patients. On staining 22.9% were having fungal and 64.12% mixed bacterial and fungal infection. Anatomically 34.7% completely recovered leaving scar. 3 eyes were eviscerated, rest not completed treatment.
Conclusion: Corneal ulcer is common eye problem in developing countries. Most of ulcers were moderate to severe grade. Treatment given on the basis of basic laboratory investigations and clinical features was effective in about 84% of patients. Severe consequences can be prevented by community based awareness.
Downloads
Download data is not yet available.
References
1. Chirambo M, Tielsch J, West K et al. Blindness and visual impairment in southern malwai. WHO bull 1986; 64(4);576-82. [PubMed]
2. Erie J, Nevitt M, Hodge D et al. Incidence of ulcerative keratitis in a defined population from 1950 through 1988. Arch ophthalmol 1993, 111(12); 1665-71. [PubMed]
3. Upadhyay M, Karmacharya P, Koirala S et al. The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for prevention of corneal ulceration in Nepal.Br Ophthalmol 2001;85(4);388-92. [PubMed]
4. Srinivasan M, Christine A, George C et al. Epidemiology & aetiological diagnosis of corneal ulceration in madurai. Br J ophthalmol 1997; 81(11):965-71. [PubMed]
5. Sharma S,Kunimoto D,Garg P et al.Evaluation of corneal scraping smear examination methods in diagnosis of bacterial and fungal keratitis :A survey of eight year of laboratory experience. Cornea2002;21(7):643-7. [PubMed]
6. Gregory S,Ogawa & Rober A, Hyndiuk in "The Cornea" by Smolin & Theoft, 3rd edition; 128.
7. Bharathi M, Ramakrishnan R, Vasu S. Epidemiology of bacterial keratitis in a referral centre in south India. Indian J Ophthalmol 2003;21(4):239-245. [PubMed]
8. Goonawardana S, Ranasinghe K, Arseculeretnae S, et al. Survey of mycotic and bacterial keratitis in Sri Lanka. Mycopathologia 1994; 127:77-81. [PubMed]
9. Vajpayee RB,Ray M,Panda A et al.Risk factors for paediatric presumed microbial keratitis: a casecontrol study. Cornea 1999;18(5):565-9. [PubMed]
10. Panda A,Satpathy G et al.Demographic pattern, predisposing factors and management of ulcerative keratitis:evaluation of thousand cases at a tertiary care centre.Clinical and experimental ophthalmol 2007;35(1):44-49.
11. Thylefors B. Epidemiological pattern of ocular of ocular trauma.Aust NZ J ophthalmol 1992(2);20:95-98.
12. Schaefer F,Bruttin O et al.Bacterial keratitis:A prospective clinical and microbiological study.Br J Ophthalmol 2001;85:842-47. [PubMed]
13. Boucier T,Thomas F et al. Bacterial Keratitis :Predisposing factors, clinical and microbiological review of 300 cases.Br J Ophthalmol 2003;87(7):430-6. [PubMed]
14. Gonxales CA, Srinivasan M, Whitcher JP, Smolin G. Incidence of corneal ulceration in maduari. Ophalmic epidemiol 1996;3(3):159-66. [PubMed]
15. Wilhelmus KR. Indecision about corticosteroids for bacterial keratitis; an evidence-based update. Ophthalmology 2002;109(5):835-42. [PubMed]
16. Bharathi M, Ramakrishnan R et al.Epidemiological characteristics and laboratory diagnosis of fungal keratitis: A three year study 2003; IJO : 51(4), 315-321. [PubMed]
17. Chander J ,Sharma A.Prevalence of fungal corneal ulcer in northern India. Infection1994;22(3):207-209. [PubMed]
18. Gopinathan U ,Garg P et al.The epidemiological features and laboratory results of fungal keratitis: a ten year review in a referral eye care centre in south India.Cornea 2002;21(6) :555-59. [PubMed]
19. Agrawal P, Roy P et al;Efficacy of systemic and topical Itraconazole as a broad spectrum anti fungal agent in mycotic corneal ulcer.A preliminary study.Indian J Ophthalmol. 2001;49(3):173-76. [PubMed]
20. Leck A,Thomas P et al.Etiology of suppurative corneal ulcer in Ghana and South India,and epidemiology of fungal keratitis.Br J Ophthalmol2002;88(11):1211-15. [PubMed]
21. Satpathy G, Vishalakshi P.Ulcerative keratitis:Microbial profile and sensitivity pattern-a five year study.Ann Ophthalmol1995:27;301-6.
22. Basak S,Mohanty A et al.Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India.Indian J ophthalmol 2005:53(1);17-22. [PubMed]
23. Choudhary A, Singh K.Spectrum of fungal keratitis in northern India.Cornea 2005:24(1);8-15. [PubMed]
24. Laspina F,Samudio M et al. Epidemiological characteristic of microbiological results on patients with infectious corneal ulcer:a 13years survey in Paraguay;Grafes Arch clin exp ophthalmol2004;242 (3) :204-9. [PubMed]
25. Khanal B,Deb M et al.Laboratory diagnosis in ulcerative keratitis; Ophthalmic Ref 2005;37(3):123-7. [PubMed]
26. Vajpayee R,Angra S,Sandramouli S et al, Laboratory diagnosis of keratomycosis:Comparative evaluation of direct Microscopy and culture results. Ann Ophthalmol 1993;25(2):68-71. [PubMed]
27. Wahl J ,Katz, H and Abrams D. Infectious Keratits in Baltimore.AnnOphthalmol,23(6):234,1991. [PubMed]
28. McDonell P,Nobel J,Gauderman W,Lee P,Aiello A,Trousdale M.Community care of corn ulcers.Am J Ophthalmol 1992;114(5):531-8. [PubMed]
29. Jones DB. Decision-making in the Management of microbial keratitis.Ophthalmology1981;88(8):814-20. [PubMed]
30. O`Day D. Selection of appropriate antifungal therapy. Cornea 1987:6(4);238-45. [PubMed]
31. O` Brien,Maguire M,Fink N et al.Efficacy of Ofloxacin vs Cefazoline and tobramycin in the therapy of bacterial keratitis report from the bacterial keratitis study group. Arch Ophthalmol 1995;113(10):1257–1265. [PubMed]
32. Prajna N,George C et al. Bacteriological and clinical efficacy, Ofloxacin 0.3% versus Ciprofloxa 0.3% ophthalmic solution in treatment of patients with culture positive bacterial keratitis. Cornea 2001:20(2) ;175-8.
33. Morlet N,Daniell M.Microbial keratitis:What the preferred initial therapy? View- 2:Empirical fluoroquinolone therapy is sufficient initial treatment.Br J Ophthalmol 2003:87(9);1169-72.
34. Getshen K, Srinivasan M, Upadhyay M, Priyadarsini B, Mahalaksmi R, Whitcher JP. Corneal ulceration in South East asia. I;: a model for the prevention of bacterial ulcers at the village level in rural Bhutan. Br J Ophthalmol 2006;90(3):276-8.
2. Erie J, Nevitt M, Hodge D et al. Incidence of ulcerative keratitis in a defined population from 1950 through 1988. Arch ophthalmol 1993, 111(12); 1665-71. [PubMed]
3. Upadhyay M, Karmacharya P, Koirala S et al. The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for prevention of corneal ulceration in Nepal.Br Ophthalmol 2001;85(4);388-92. [PubMed]
4. Srinivasan M, Christine A, George C et al. Epidemiology & aetiological diagnosis of corneal ulceration in madurai. Br J ophthalmol 1997; 81(11):965-71. [PubMed]
5. Sharma S,Kunimoto D,Garg P et al.Evaluation of corneal scraping smear examination methods in diagnosis of bacterial and fungal keratitis :A survey of eight year of laboratory experience. Cornea2002;21(7):643-7. [PubMed]
6. Gregory S,Ogawa & Rober A, Hyndiuk in "The Cornea" by Smolin & Theoft, 3rd edition; 128.
7. Bharathi M, Ramakrishnan R, Vasu S. Epidemiology of bacterial keratitis in a referral centre in south India. Indian J Ophthalmol 2003;21(4):239-245. [PubMed]
8. Goonawardana S, Ranasinghe K, Arseculeretnae S, et al. Survey of mycotic and bacterial keratitis in Sri Lanka. Mycopathologia 1994; 127:77-81. [PubMed]
9. Vajpayee RB,Ray M,Panda A et al.Risk factors for paediatric presumed microbial keratitis: a casecontrol study. Cornea 1999;18(5):565-9. [PubMed]
10. Panda A,Satpathy G et al.Demographic pattern, predisposing factors and management of ulcerative keratitis:evaluation of thousand cases at a tertiary care centre.Clinical and experimental ophthalmol 2007;35(1):44-49.
11. Thylefors B. Epidemiological pattern of ocular of ocular trauma.Aust NZ J ophthalmol 1992(2);20:95-98.
12. Schaefer F,Bruttin O et al.Bacterial keratitis:A prospective clinical and microbiological study.Br J Ophthalmol 2001;85:842-47. [PubMed]
13. Boucier T,Thomas F et al. Bacterial Keratitis :Predisposing factors, clinical and microbiological review of 300 cases.Br J Ophthalmol 2003;87(7):430-6. [PubMed]
14. Gonxales CA, Srinivasan M, Whitcher JP, Smolin G. Incidence of corneal ulceration in maduari. Ophalmic epidemiol 1996;3(3):159-66. [PubMed]
15. Wilhelmus KR. Indecision about corticosteroids for bacterial keratitis; an evidence-based update. Ophthalmology 2002;109(5):835-42. [PubMed]
16. Bharathi M, Ramakrishnan R et al.Epidemiological characteristics and laboratory diagnosis of fungal keratitis: A three year study 2003; IJO : 51(4), 315-321. [PubMed]
17. Chander J ,Sharma A.Prevalence of fungal corneal ulcer in northern India. Infection1994;22(3):207-209. [PubMed]
18. Gopinathan U ,Garg P et al.The epidemiological features and laboratory results of fungal keratitis: a ten year review in a referral eye care centre in south India.Cornea 2002;21(6) :555-59. [PubMed]
19. Agrawal P, Roy P et al;Efficacy of systemic and topical Itraconazole as a broad spectrum anti fungal agent in mycotic corneal ulcer.A preliminary study.Indian J Ophthalmol. 2001;49(3):173-76. [PubMed]
20. Leck A,Thomas P et al.Etiology of suppurative corneal ulcer in Ghana and South India,and epidemiology of fungal keratitis.Br J Ophthalmol2002;88(11):1211-15. [PubMed]
21. Satpathy G, Vishalakshi P.Ulcerative keratitis:Microbial profile and sensitivity pattern-a five year study.Ann Ophthalmol1995:27;301-6.
22. Basak S,Mohanty A et al.Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India.Indian J ophthalmol 2005:53(1);17-22. [PubMed]
23. Choudhary A, Singh K.Spectrum of fungal keratitis in northern India.Cornea 2005:24(1);8-15. [PubMed]
24. Laspina F,Samudio M et al. Epidemiological characteristic of microbiological results on patients with infectious corneal ulcer:a 13years survey in Paraguay;Grafes Arch clin exp ophthalmol2004;242 (3) :204-9. [PubMed]
25. Khanal B,Deb M et al.Laboratory diagnosis in ulcerative keratitis; Ophthalmic Ref 2005;37(3):123-7. [PubMed]
26. Vajpayee R,Angra S,Sandramouli S et al, Laboratory diagnosis of keratomycosis:Comparative evaluation of direct Microscopy and culture results. Ann Ophthalmol 1993;25(2):68-71. [PubMed]
27. Wahl J ,Katz, H and Abrams D. Infectious Keratits in Baltimore.AnnOphthalmol,23(6):234,1991. [PubMed]
28. McDonell P,Nobel J,Gauderman W,Lee P,Aiello A,Trousdale M.Community care of corn ulcers.Am J Ophthalmol 1992;114(5):531-8. [PubMed]
29. Jones DB. Decision-making in the Management of microbial keratitis.Ophthalmology1981;88(8):814-20. [PubMed]
30. O`Day D. Selection of appropriate antifungal therapy. Cornea 1987:6(4);238-45. [PubMed]
31. O` Brien,Maguire M,Fink N et al.Efficacy of Ofloxacin vs Cefazoline and tobramycin in the therapy of bacterial keratitis report from the bacterial keratitis study group. Arch Ophthalmol 1995;113(10):1257–1265. [PubMed]
32. Prajna N,George C et al. Bacteriological and clinical efficacy, Ofloxacin 0.3% versus Ciprofloxa 0.3% ophthalmic solution in treatment of patients with culture positive bacterial keratitis. Cornea 2001:20(2) ;175-8.
33. Morlet N,Daniell M.Microbial keratitis:What the preferred initial therapy? View- 2:Empirical fluoroquinolone therapy is sufficient initial treatment.Br J Ophthalmol 2003:87(9);1169-72.
34. Getshen K, Srinivasan M, Upadhyay M, Priyadarsini B, Mahalaksmi R, Whitcher JP. Corneal ulceration in South East asia. I;: a model for the prevention of bacterial ulcers at the village level in rural Bhutan. Br J Ophthalmol 2006;90(3):276-8.
CITATION
DOI: 10.17511/ijmrr.2014.i01.07
Published: 2014-02-28
How to Cite
1.
Khare P, Shrivastava M, Kumar K. Study of epidemiological characters, predisposing factors and treatment outcome of corneal ulcer patients. Int J Med Res Rev [Internet]. 2014Feb.28 [cited 2024Nov.21];2(1):33-9. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/55
Section
Original Article
OAI - Open Archives Initiative
