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G. J. Lee, E. Baghdasaryan, F. Yu, A. J. Aldave, R. Casey, S. X. Deng; Elevated Intraocular Pressure is a Common Complication During Severe Infectious Keratitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2887.
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To describe the risk factors, clinical characteristics and outcomes of the infectious keratitis associated with elevated intraocular pressure (IOP) during the acute infection.
A retrospective review of 220 cases of culture-proven infectious keratitis at a single institution from January 2003 to December 2007. Elevated IOP was defined as IOP > 21 mm Hg. Ten risk factors including a history of contact lens wear, history of previous ocular trauma in the involved eye, prior ocular surgery, diabetes mellitus(DM), neurotrophic keratits, exposure keratitis, systemic immunosuppression, remote history of topical steroid use, glaucoma and ulcer size were evaluated to determine whether they were associated with elevated IOP. Outcome measures included the necessity of penetrating keratoplasty, evisceration and visual acuity at resolution. The pathogens accounted for the infection were identified.
Elevation in IOP ranged from 22 to 51 mm Hg and occurred in 52 of 220 cases of infection (23.6%). Among all 10 risk factors studied in the elevated IOP group (K-IOP) and the normal IOP group (control), prior ocular surgery, history of DM, glaucoma and larger ulcer size (≥ 4.0 mm) were significantly associated with the development of elevated IOP (p< 0.05) during the acute infection. No association was found between the specific type of pathogens and the risk of developing elevated IOP. Penetrating keratoplasty was performed in 31% of patients in the K-IOP group vs. 9 % in the control group (p< 0.001). There were significantly more patients achieved visual acuity of 20/50 or better at the time of ulcer resolution in the control (44%) than in the K-IOP group 8% (p= 0.001).
Elevated IOP was detected in a significant population of patients with active infectious keratitis and it was associated with poorer outcomes. Close monitoring and prompt treatment of elevated IOP are recommended to prevent complications associated with high IOP.
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