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Otman sandali, Thomas Gaujoux, Pablo Goldschmidt, Djida Benallaoua, Laurent Laroche, Vincent Borderie; Infectious Keratitis In Limbal Stem Cell Deficiency: Characteristics And Risk Factors. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5121.
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The aim of this study was to evaluate the incidence, clinical characteristics, causative organisms, risk factors, and visual outcome of infectious keratitis in patients with severe limbal stem cell deficiency.
Retrospective comparative case control series of thirty five patients (35 eyes) who presented severe limbal stem cell deficiency between January 1993 and September 2010. The study group included 14 patients who had at least one episode of infectious keratitis. The control group included 21 patients who had no corneal infections. The incidence, risk factors, clinical and microbiological characteristics of infectious keratitis. were recorded.
The mean follow-up time was 46 months (95%-confidence interval: 31-61 months).The incidence of infectious keratitis in all patients with limbal stem cell deficiency during follow-up was 1,400/year/10,000 patients. They were mainly caused by Gram positive bacteria (94%). Sixty-two percent of Staphylococcus species were resistant to fluoroquinolons. Keratitis were located centrally in 14 cases (74%). The mean size of the corneal abscess was 4.6+2.8 mm2. Stromal involvement and anterior chamber reaction were found in 15 cases (79%). Only 7 keratitis (37%) healed under fortified adapted antibiotic drops with no surgical procedures. In 8 cases (42%), amniotic membrane transplantation was required and in 4 cases (21%) «à chaud» keratoplasty was performed. No eyes required enucleation or evisceration. The pre-infectious LogMAR visual acuity was 1.96+0,54 and the final LogMAR visual acuity was 2.15+0.60. Significant risk factors associated with infectious keratitis were: contact lens wear, history of persistent epithelial defect, number of quadrants with neovascularization, required time for re-epithelialization after amniotic membrane or corneal transplantation, and use of corticosteroid and ciclosporin eye drops.
Infectious keratitis in patients with limbal stem cell deficiency are frequent, severe, and caused mainly by Gram positive bacteria. The recognition of risk factors may help to identify patients at greater risk of developing infectious keratitis. The restoration of the epithelial barrier integrity and a close follow-up of contact lenses may help to prevent infection.
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