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Vishal Jhanji, Alvin Young, K. Leung, Nicole Tsim, Mamie Hui, Lulu Cheng; Clinical and Microbiological profile of Paediatric Keratitis in a tertiary care hospital in Hong Kong. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2906.
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Microbial keratitis is a serious cause of ocular morbidity in pediatric age group. In this study, we retrospectively evaluated the clinical and microbiological profile of cases of pediatric keratitis presenting to a tertiary care hospital in Hong Kong.
All cases of microbial keratitis in pediatric age group (< 18 years) who had presented to our hospital between January 2000 and December 2010 were identified. A retrospective review of medical records was conducted. The medical records were reviewed for associated risk factors, microbiological profile, pre- and post-treatment visual acuity, treatment modalities, and, final outcomes.
Overall, 18 patients (male: female; 5: 13) were recruited. The mean age was 12.4 years (range: 3-17 years). The most common associated risk factor was contact lens wear, identified in 15 (83.3%) patients. 7/15 eyes were associated with orthokeratolgy lens overnight wear. 2 cases were related to intrinsic keratopathy (exposure keratopathy and vernal keratitis). Only 1 eye was infected secondary to trauma. 6 out of 18 eyes showed positive smear results (5 gram negative bacilli, 1 gram positive cocci). 16 out of 18 eyes showed positive cultures. On microbiological culture, 14 cases had a single pathogen identified and 2 cases had a co-infection. Pseudomonas sp. was the most commonly isolated organism (10 eyes, 62.5%), followed by coagulase -ve staphylococci (5 eyes, 31.2%) and Corynebacterium sp. (2 eyes, 12.5%). All Pseudomonas infections were related to contact lens wear. 14 eyes were treated with fortified antibiotics and 4 were treated with intensive topical levofloxacin. One case with trauma required multiple surgeries including tectonic penetrating keratoplasty followed by lens aspiration and retinal detachment repair. At the last follow-up, 13 out of the 17 eyes (76.5%) had best-corrected visual acuity (BCVA) 20/40 or better, 3 (17.6%) had BCVA between 20/50 and 20/100, and 1 (5.9%) had BCVA < 20/200. Corneal scarring was documented in 13 eyes after treatment. One case required optical deep anterior lamellar keratoplasty and achieved 20/20 with the aid of rigid gas permeable contact lens.
Microbial keratitis in pediatric age group was mostly associated with contact lens wear in our cohort. Prompt diagnosis and treatment of these cases resulted in good visual outcomes without the need of invasive surgery in most patients.
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