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Meredith Remmer, Sonia Belliappa, David Howard; Outcomes of Central Corneal Ulcer in an Underserved Population. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3572.
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To examine cases of central corneal ulcer in an underserved urban population in order to determine factors associated with favorable and poor outcomes.
We performed a retrospective chart review to identify all cases of central corneal ulcer followed by the Ophthalmology Department during the time period from 2007 to 2011 at Bellevue Hospital Center in New York, NY. We recorded parameters such as age, gender, soft contact lens wear, ulcer size, visual acuity at presentation and post-treatment, use of systemic and fortified topical antibiotics, use of topical steroids, culture results, duration of treatment, and development of corneal perforation.
We identified a total of 25 cases of central corneal ulcer in the study period. Nine of these patients progressed to corneal perforation despite aggressive medical therapy. A larger size of the corneal ulcer at presentation was significantly associated with corneal perforation, with a mean maximal diameter of 7.71 mm in patients who perforated versus a mean maximal diameter of 3.27 mm in those who did not perforate (p <0.01). We also found a statistically significant difference in mean age among the patients who had a corneal perforation (59.7 years) as compared to the patients who did not perforate (44.1 years; p <0.05). In addition, patients who perforated were more likely to have positive corneal cultures than patients who did not perforate (odds ratio: 3.56, 95% confidence interval: 1.58-8.57). Gender and usage of soft contact lenses, systemic antibiotics, topical fortified antibiotics, or topical steroids did not significantly correlate with development of perforation.
Larger ulcer size, positive culture results, and advanced age were found to be significantly associated with poor outcome in patients with central corneal ulcers at our institution. Overall, the results of our research suggest that these parameters may help in stratifying risk and determining which patients may require even more intensive therapy. In an urban population with uncertain compliance and access to medical care, especially in older patients, clinicians should have a low threshold for instituting aggressive therapy to prevent adverse outcomes.
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