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Liwu Grace Chen, Kristin M Hammersmith, Parveen Nagra, Nina Ni, Christopher J Rapuano; Surgical Interventions for Microbial Keratitis: a Four-Year Experience in Pennsylvania. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5464.
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To review characteristics of microbial keratitis resulting in surgical intervention at a Pennsylvania institution over a four year period.
A retrospective review all patients with microbial corneal ulcers with associated corneal cultures at the Cornea Service, Wills Eye Hospital between January 1st 2009 and December 31st 2012 were included. Data were collected using the electronic medical records database, which provided demographic information, exam details, historical information, culture results, and interventions undertaken.
A total of 315 patients with infectious keratitis were included, 44 (14%) of whom needed intervention (Penetrating keratoplasty (PK) 5.7%, glue 1.6%, enucleation/evisceration 0.9%, tarsorrhaphy 3.5%, Prokera 1.3%, K-pro 0.6%, Lasik flap excision 0.3%). The average age at presentation of all ulcers was 55.9 ± 23.6 whereas the average age for intervention group was 66.7± 22.1, 70% of whom were women. For the PK group, 61% was bacterial, 17% fungal, 5.5% acanthamoeba. Of all ulcer patients, 33% were on steroid drops. Those requiring PK, 56% was on steroid drops. Time for epithelial defect to heal (days) for intervention group was as follows: bacterial (38), fungal (58), acanthamoeba (165), polymicrobial (41) and culture negative (64). The average duration of treatment (days) to intervention for each of the groups is as follows: PK 54.1, glue 89.5, enucleation/evisceration 11, tarsorrhaphy 57.7, Prokera 46, K-pro 28, Lasik flap excision 55.
Of all ulcer patients, older patients and women were more likely to require surgical intervention compared to younger patients. PK accounts for the largest number of intervention (41%), and bacterial keratitis is the major cause of ulcers requiring PK. Being on steroid drops appears to be associated with an increased likelihood of requiring a PK.
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